European Radiology

, Volume 27, Issue 7, pp 2835–2842 | Cite as

String-like lumen in below-the-knee chronic total occlusions on contrast-enhanced magnetic resonance angiography predicts intraluminal recanalization and better blood flow restoration

  • Yue-Qi Zhu
  • Hai-Tao Lu
  • Li-Ming Wei
  • Fang Liu
  • Ying-Sheng Cheng
  • Jian-Bo Wang
  • Jun-Gong Zhao



To determine whether string-like lumina (SLs) on contrast-enhanced magnetic resonance angiography (CE-MRA) predict better outcomes in diabetic patients with below-the-knee (BTK) chronic total occlusions (CTOs).


This study involved 317 long-segment (>5 cm) BTK CTOs of 245 patients that were examined using CE-MRA and treated using endovascular angioplasty. An SL with a CTO was slowly filled with blood on conventional CE-MRA. Univariate and multivariate analyses were performed to identify predictors of procedural success, recanalisation method and immediate blood flow restoration. The target-lesion patency and limb-salvage rates were assessed.


SL-positive CTOs (n = 60) achieved a higher technique success rate, preferred intraluminal angioplasty and better blood flow restoration than SL-negative CTOs (n = 257, P < 0.05). Multivariate analyses revealed that lesion length was the independent predictor of procedural success (P = 0.028). SL was a predictor of intraluminal angioplasty (P < 0.001) and good blood-flow restoration (P = 0.004). Kaplan-Meier analyses at 12 months revealed a higher target lesion patency rate (P = 0.04) and limb-salvage rate (P = 0.35) in SL-positive CTOs.


In patients with BTK CTOs, SL predicted intraluminal angioplasty and good blood-flow restoration for BTK CTOs.

Key points

Intraluminal recanalisation was more frequently used for BTK-CTOs with SLs than without

CTO length was the only independent predictor of successful CTO recanalisation

SL was the only predictor of intraluminal angioplasty for BTK-CTOs

SL and CTO length were predictors of good blood-flow restoration after recanalisation

Restenosis-free and limb-salvage rates were better for SL-positive CTOs than SL-negative CTOs


Diabetes Critical limb ischaemia Angioplasty Below the knee Runoff 



The scientific guarantor of this publication is Jun-Gong Zhao. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by the National Natural Science Foundation of China (nos. 81370041 and 81271683). One of the authors has significant statistical expertise.

Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subject or cohorts have been previously reported.

Methodology: retrospective, cross-sectional study, performed at one institution.


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Yue-Qi Zhu
    • 1
  • Hai-Tao Lu
    • 1
  • Li-Ming Wei
    • 1
  • Fang Liu
    • 2
  • Ying-Sheng Cheng
    • 1
  • Jian-Bo Wang
    • 1
  • Jun-Gong Zhao
    • 1
  1. 1.Department of Diagnostic and Interventional RadiologyShanghai Jiao Tong University Affiliated Sixth People’s HospitalShanghaiChina
  2. 2.Department of EndocrinologyShanghai Jiao Tong University Affiliated Sixth People’s HospitalShanghaiChina

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