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Impact of “black rock” on clinical outcomes after endovascular therapy for de novo calcified femoropopliteal lesions

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Abstract

The relationship between severity of calcification and clinical outcomes after endovascular therapy (EVT) for femoropopliteal lesions is well known. We often encounter dense calcifications in our daily practice, which are darker than normal calcifications on angiography. Accordingly, we named it “black rock” (BR), and investigated its impact on clinical outcomes after EVT. We retrospectively analyzed 677 lesions in 495 patients who underwent EVT for de novo calcified femoropopliteal lesions at our hospital between April 2007 and June 2020. BR is defined as a calcification which is 1 cm or more in length, occupies more than half of the vessel diameter, and appears darker than the body of the femur on angiography. Propensity score matching analysis was performed to compare clinical outcomes between lesions with BR [BR (+) group] and without BR [BR (−) group]. A total of 119 matched pairs of lesions were analyzed. Primary patency at 2 years was significantly lower in the BR (+) group than in the BR (−) group (48% vs. 75%, p = .0007). Multivariate analysis revealed that the presence of BR [hazard ratio (HR) = 2.23, 95% confidence interval (CI); 1.48–3.38, p = .0001], lesion length (HR = 1.03, 95%CI; 1.00–1.06, p = .0244), and no scaffold use (HR = 1.58, 95%CI; 1.06–2.36, p = .0246) were predictors of restenosis. The presence of BR is independently associated with clinical outcomes after EVT for de novo calcified femoropopliteal lesions.

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References

  1. Aboyans V, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C; ESC Scientific Document Group (2018) 2017 ESC Guidelines on the Diagnosis and Treatment of peripheral arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Endorsed by: the European Stroke Organization (ESO) The Task Force for the diagnosis and treatment of peripheral arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 39:763–816

    Article  Google Scholar 

  2. Itoga NK, Kim T, Sailer AM, Fleischmann D, Mell MW (2017) Lower extremity computed tomography angiography can help predict technical success of endovascular revascularization in the superficial femoral and popliteal artery. J Vasc Surg 66:835-843.e1

    Article  PubMed  PubMed Central  Google Scholar 

  3. Okuno S, Iida O, Shiraki T, Fujita M, Masuda M, Okamoto S, Ishihara T, Nanto K, Kanda T, Takahara M, Uematsu M (2016) Impact of Calcification on Clinical Outcomes After Endovascular Therapy for Superficial femoral artery disease: assessment Using the peripheral artery Calcification Scoring System. J Endovasc Ther 23:731–737

    Article  PubMed  Google Scholar 

  4. Fujihara M, Kozuki A, Tsubakimoto Y, Takahara M, Shintani Y, Fukunaga M, Iwasaki Y, Nakama T, Yokoi Y (2019) Lumen gain after endovascular therapy in calcified superficial femoral artery occlusive disease assessed by intravascular ultrasound (CODE study). J Endovasc Ther 26:322–330

    Article  PubMed  Google Scholar 

  5. Tokuda T, Oba Y, Koshida R, Suzuki Y, Murata A, Ito T (2020) The impact of femoropopliteal artery calcium score after endovascular treatment. Ann Vasc Surg 66:543–553

    Article  PubMed  Google Scholar 

  6. Soga Y, Iida O, Hirano K, Suzuki K, Tosaka A, Yokoi H, Nobuyoshi M (2011) Utility of new classification based on clinical and lesional factors after self-expandable nitinol stenting in the superficial femoral artery. J Vasc Surg 54:1058–1066

    Article  PubMed  Google Scholar 

  7. Austin PC (2011) Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat 10:150–161

    Article  PubMed  Google Scholar 

  8. Wexler L, Brundage B, Crouse J, Detrano R, Fuster V, Maddahi J, Rumberger J, Stanford W, White R, Taubert K (1996) Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association. Circulation 94:1175–1192

    Article  CAS  PubMed  Google Scholar 

  9. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832

    Article  CAS  PubMed  Google Scholar 

  10. Alexopoulos D, Papathanasiou M, Kalogeropoulou C, Xanthopoulou I, Diamantopoulos A, Tsigkas G, Davlouros P, Hahalis G, Siablis D (2012) Coronary artery calcium detection using flat panel digital cinefluoroscopy: comparison to coronary artery calcium score assessed with multiple detector computerized tomography. Int J Cardiol 158:370–375

    Article  PubMed  Google Scholar 

  11. Zheng X, Xu K, Yang X, Yang W, Zhang W, Jiang Y, Zhang Y, Qiu X, Shi H, Jiang L, Shen L, He B (2022) Association between coronary artery calcium score and in-stent restenosis after drug-eluting stent implantation. Coron Artery Dis 33:284–294

    Article  PubMed  Google Scholar 

  12. Rastan A, Brodmann M, Böhme T, Macharzina R, Noory E, Beschorner U, Flügel PC, Bürgelin K, Neumann FJ, Zeller T (2021) Atherectomy and drug-coated balloon angioplasty for the treatment of long infrapopliteal lesions: a randomized controlled trial. Circ Cardiovasc Interv 14:e010280

    Article  CAS  PubMed  Google Scholar 

  13. Tepe G, Brodmann M, Werner M, Bachinsky W, Holden A, Zeller T, Mangalmurti S, Nolte-Ernsting C, Bertolet B, Scheinert D, Gray WA, Disrupt PAD III, Investigators, (2021) Intravascular lithotripsy for peripheral artery calcification: 30-day outcomes from the randomized Disrupt PAD III trial. JACC Cardiovasc Interv 14:1352–1361

    Article  PubMed  Google Scholar 

  14. Iida O, Urasawa K, Shibata Y, Yamamoto Y, Ando H, Fujihara M, Nakama T, Miyashita Y, Mori S, Diaz-Cartelle J, Soga Y (2022) Clinical safety and efficacy of rotational atherectomy in Japanese patients with peripheral arterial disease presenting femoropopliteal lesions: The J-SUPREME and J-SUPREME II Trials. J Endovasc Ther 29:240–247

    Article  PubMed  Google Scholar 

  15. Kokkinidis DG, Jawaid O, Cantu D, Martinsen BJ, Igyarto Z, Valle JA, Waldo SW, Armstrong EJ (2020) Two-year ouctomes of orbital atherectomy combined with drug-coated balloon angioplasty for treatment of heavily calcified femoropopliteal lesions. J Endovasc Ther 27:492–501

    Article  PubMed  Google Scholar 

  16. Giusca S, Lichtenberg M, Schueler M, Heinrich U, Eisenbach C, Andrassy M, Korosoglou G (2021) Safety, effectiveness and mid-term follow-up in 136 consecutive patients with moderate to severely calcified lesions under going phoenixatherectomy. Heart Vessels 36:366–375

    Article  PubMed  Google Scholar 

  17. Konishi H, Koshida R, Habara M, Nasu K, Hirano K, Kinoshita Y, Tsuchikane E, Terashima M, Matsubara T, Suzuki T (2022) The effect of aggressive wire recanalization in calcified atheroma and dilatation (Arcadia) technique in eccentric calcified lesion of no-stenting zone. J Endovasc Ther 29:536–543

    Article  PubMed  Google Scholar 

  18. Criqui MH, Denenberg JO, Ix JH, McClelland RL, Wassel CL, Rifkin DE, Carr JJ, Budoff MJ, Allison MA (2014) Calcium density of coronary artery plaque and risk of incident cardiovascular events. JAMA 311:271–278

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Al Rifai M, Kanaya AM, Kandula NR, Patel J, Al-Mallah MH, Budoff M, Cainzos-Achirica M, Criqui MH, Virani SS (2022) Association of coronary artery calcium density and volume with predicted atherosclerotic cardiovascular disease risk and cardiometabolic risk factors in South Asians: the mediators of atherosclerosis in South Asians living in America (MASALA) study. Curr Probl Cardiol 101105.

  20. Fanelli F, Cannavale A, Gazzetti M, Lucatelli P, Wlderk A, Cirelli C, d’Adamo A, Salvatori FM (2014) Calcium burden assessment and impact on drug-eluting balloons in peripheral arterial disease. Cardiovasc Intervent Radiol 37:898–907

    Article  CAS  PubMed  Google Scholar 

  21. Tzafriri AR, Garcia-Polite F, Zani B, Stanley J, Muraj B, Knutson J, Kohler R, Markham P, Nikanorov A, Edelman ER (2017) Calcified plaque modification alters local drug delivery in the treatment of peripheral atherosclerosis. J Control Release 264:203–210

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Yoshioka N, Tokuda T, Koyama A, Yamada T, Shimamura K, Nishikawa R, Morita Y, Morishima I (2023) Two-year clinical outcomes and predictors of restenosis following the use of polymer-coated paclitaxel-eluting stents or drug-coated balloons in patients with femoropopliteal artery disease. Heart Vessels 38:429–437

    Article  PubMed  Google Scholar 

  23. Dias-Neto M, Matschuck M, Bausback Y, Banning-Eichenseher U, Steiner S, Branzan D, Staab H, Varcoe RL, Scheinert D, Schmidt A (2018) Endovascular treatment of severely calcified femoropopliteal lesions using the “Pave-and-Crack” technique: technical description and 12-month results. J Endovasc Ther 25:334–342

    Article  PubMed  Google Scholar 

  24. Goltz JP, Kleemann M (2015) Complex recanalization techniques for complex femoro-popliteal lesions: how to optimize outcomes. J Cardiovasc Surg (Torino) 56:31–41

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, 3-6- Shimosueyoshi, Tsurumi-Ku, Yokohama City, Kanagawa, 230-0012, Japan

    Shinsuke Mori, Masahiro Yamawaki, Tomoya Fukagawa, Kohei Yamaguchi, Masafumi Mizusawa, Shigemitsu Shirai, Yohsuke Honda, Masakazu Tsutsumi, Norihiro Kobayashi & Yoshiaki Ito

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  1. Shinsuke Mori
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  2. Masahiro Yamawaki
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  3. Tomoya Fukagawa
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  4. Kohei Yamaguchi
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  5. Masafumi Mizusawa
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  6. Shigemitsu Shirai
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  9. Norihiro Kobayashi
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Correspondence to Shinsuke Mori.

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Mori, S., Yamawaki, M., Fukagawa, T. et al. Impact of “black rock” on clinical outcomes after endovascular therapy for de novo calcified femoropopliteal lesions. Heart Vessels 38, 1356–1363 (2023). https://doi.org/10.1007/s00380-023-02284-3

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