Jacob W Hartwig1, Drew J Braet1, Jamie B Smith2, Jonathan Bath1, Todd R Vogel1. 1. Division of Vascular Surgery, Department of Surgery, University of Missouri, School of Medicine, Columbia, MO, USA. 2. Department of Family and Community Medicine, University of Missouri, School of Medicine Columbia, Columbia, MO, USA.
Abstract
BACKGROUND: The optical coherence tomography (OCT) catheter, Ocelot (Avinger Inc., Redwood City, CA), has been utilized to cross Trans-Atlantic Inter-Society Consensus Document (TASC) D lesions. Studies have assessed the characteristics of high-risk plaques in the carotid artery, but few, if any data exist evaluating OCT and plaque morphology in the superficial femoral artery (SFA). This study assessed SFA plaque morphology using OCT and lesion crossing success in chronic total occlusions (CTOs). METHODS: We reviewed patients who underwent attempted infrainguinal revascularization with TASC D CTOs using the Ocelot catheter between June 2014 and June 2018, and recorded demographic information, smoking status, and medical comorbidities. A matched cohort of 44 successfully crossed lesions was compared to 44 that failed; images insufficient for analysis were excluded. The morphology of the plaque was studied using OCT at the proximal cap, midpoint of the lesion, and the distal cap. Morphologic data studied included the intima-media thickness ratio, cross-sectional area of the plaque, and gray-scale median of the plaque. RESULTS: A total of 140 patients who underwent lower extremity procedures for TASC D lesions of the SFA with OCT imaging were reviewed with a crossing rate of 69.0%. No significant differences were found between crossed and uncrossed lesions for intima-media thickness or cross-sectional area at the proximal cap, the midpoint, or the distal cap. A lower gray-scale median at the proximal cap was associated with the ability to cross the chronic SFA occlusion (P=0.05). Subgroup analysis stratified by smoking and calcium content also demonstrated that a lower gray-scale median at the proximal cap was associated with the ability to cross the chronic SFA occlusion (P=0.01 and P=0.04, respectively). CONCLUSIONS: Lower gray-scale median at the proximal cap of a chronic SFA occlusion calculated using OCT images was associated with the ability to successfully cross the lesion. Higher plaque gray-scale median is correlated with increased calcium, greater fibrous tissue, and signal-rich plaques. Gray-scale median in the proximal cap is useful marker to determine plaque composition and subsequent technical success for crossing chronic SFA occlusions. Further studies are needed to fully determine the utility of OCT images to predict successful endovascular revascularization of chronic SFA occlusions. 2021 Quantitative Imaging in Medicine and Surgery. All rights reserved.
BACKGROUND: The optical coherence tomography (OCT) catheter, Ocelot (Avinger Inc., Redwood City, CA), has been utilized to cross Trans-Atlantic Inter-Society Consensus Document (TASC) D lesions. Studies have assessed the characteristics of high-risk plaques in the carotid artery, but few, if any data exist evaluating OCT and plaque morphology in the superficial femoral artery (SFA). This study assessed SFA plaque morphology using OCT and lesion crossing success in chronic total occlusions (CTOs). METHODS: We reviewed patients who underwent attempted infrainguinal revascularization with TASC D CTOs using the Ocelot catheter between June 2014 and June 2018, and recorded demographic information, smoking status, and medical comorbidities. A matched cohort of 44 successfully crossed lesions was compared to 44 that failed; images insufficient for analysis were excluded. The morphology of the plaque was studied using OCT at the proximal cap, midpoint of the lesion, and the distal cap. Morphologic data studied included the intima-media thickness ratio, cross-sectional area of the plaque, and gray-scale median of the plaque. RESULTS: A total of 140 patients who underwent lower extremity procedures for TASC D lesions of the SFA with OCT imaging were reviewed with a crossing rate of 69.0%. No significant differences were found between crossed and uncrossed lesions for intima-media thickness or cross-sectional area at the proximal cap, the midpoint, or the distal cap. A lower gray-scale median at the proximal cap was associated with the ability to cross the chronic SFA occlusion (P=0.05). Subgroup analysis stratified by smoking and calcium content also demonstrated that a lower gray-scale median at the proximal cap was associated with the ability to cross the chronic SFA occlusion (P=0.01 and P=0.04, respectively). CONCLUSIONS: Lower gray-scale median at the proximal cap of a chronic SFA occlusion calculated using OCT images was associated with the ability to successfully cross the lesion. Higher plaque gray-scale median is correlated with increased calcium, greater fibrous tissue, and signal-rich plaques. Gray-scale median in the proximal cap is useful marker to determine plaque composition and subsequent technical success for crossing chronic SFA occlusions. Further studies are needed to fully determine the utility of OCT images to predict successful endovascular revascularization of chronic SFA occlusions. 2021 Quantitative Imaging in Medicine and Surgery. All rights reserved.
Authors: Arne Schwindt; Bernhard Reimers; Dierk Scheinert; Matthew Selmon; John P Pigott; Jon C George; Greg Robertson; Sean Janzer; Huey B McDaniel; Gataum V Shrikhande; Giovanni Torsello; Johannes Schaefers; Salvatore Saccà; Francesco Versaci Journal: EuroIntervention Date: 2013-11 Impact factor: 6.534
Authors: Hester M Den Ruijter; Sanne A E Peters; Todd J Anderson; Annie R Britton; Jacqueline M Dekker; Marinus J Eijkemans; Gunnar Engström; Gregory W Evans; Jacqueline de Graaf; Diederick E Grobbee; Bo Hedblad; Albert Hofman; Suzanne Holewijn; Ai Ikeda; Maryam Kavousi; Kazuo Kitagawa; Akihiko Kitamura; Hendrik Koffijberg; Eva M Lonn; Matthias W Lorenz; Ellisiv B Mathiesen; Giel Nijpels; Shuhei Okazaki; Daniel H O'Leary; Joseph F Polak; Jackie F Price; Christine Robertson; Christopher M Rembold; Maria Rosvall; Tatjana Rundek; Jukka T Salonen; Matthias Sitzer; Coen D A Stehouwer; Jacqueline C Witteman; Karel G Moons; Michiel L Bots Journal: JAMA Date: 2012-08-22 Impact factor: 56.272