Factors in Sufficient Endovascular Vessel Preparation for Severely Calcified Femoropopliteal Lesions

• Published in: Circulation Journal Vol. 87; no. 3; pp. 424 - 431
• Main Authors: Kurata, Naoya, Iida, Osamu, Asai, Mitsutoshi, Okamoto, Shin, Ishihara, Takayuki, Nanto, Kiyonori, Tsujimura, Takuya, Hata, Yosuke, Toyoshima, Taku, Higashino, Naoko, Nakao, Sho, Mano, Toshiaki
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 24.02.2023
• Subjects: Aged; Aged, 80 and over; Angioplasty, Balloon; Calcification; Endovascular therapy; Female; Femoral Artery; Femoropopliteal artery; Humans; Intravascular ultrasound; Male; Peripheral Arterial Disease - therapy; Popliteal Artery; Stents; Treatment Outcome; Vessel preparation; Calcification; Endovascular therapy; Intravascular ultrasound; Femoropopliteal artery; Vessel preparation
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-22-0444

Background: Vessel preparation for endovascular treatment (EVT) is important but because the contributory factors for favorable outcomes are not yet known, we conducted the present study to elucidate the factors associated with sufficient vessel preparation for severely calcified femoropopliteal (FP) lesions.Methods and Results: This was a single-center retrospective observational study of 97 patients (mean age, 75±8 years, 76% male) with 106 de novo severely calcified FP lesions who underwent EVT under intravascular ultrasound (IVUS) evaluation. The lesion definition was 360° of superficial calcification on IVUS. The primary outcome measure was sufficient vessel preparation, which was defined as successful cracking of severely calcified lesions evaluated by IVUS after predilation. The mean lesion length was 200±103 mm, and chronic total occlusion was present in 38% of patients. According to the greater difference between the preballoon size and the lumen diameter of the severely calcified lesion, the frequency of sufficient vessel preparation increased (odds ratio, 4.68; 95% confidence interval, 2.09–10.49; P<0.01). Balloon type (noncompliant, P=0.80; scoring: P=0.25) and pressure (P=0.27) were non-contributory.Conclusions: The difference between the lumen diameter at the severely calcified FP lesion site and the preballoon dilatation diameter was the sole factor contributing to sufficient vessel preparation.