In the Journals

Heavy calcification linked to poor outcomes after endovascular treatment for SFA disease

Heavy calcification was associated with adverse clinical outcomes such as poor patency and major adverse limb events after endovascular therapy for de novo superficial femoral artery lesions, researchers reported.

Shota Okuno, MD, from Kansai Rosai Hospital Cardiovascular Center in Amagasaki, Hyogo, Japan, and colleagues analyzed data from 394 Japanese patients (mean age, 72 years; 290 men) who had undergone successful endovascular therapy (residual angiographic stenosis < 30%) for de novo superficial femoral artery (SFA) lesions from 2010 to 2013.

Fifty-seven percent (n = 223) of the patients had diabetes and 21% (n = 81) required regular dialysis due to end-stage renal disease. Stents were implanted in 80% (n = 315) of the patients, with 253 (80%) receiving bare-metal stents and 62 (20%) given drug-eluting stents.

The researchers used the peripheral artery calcification scoring system (PACCS), which employs fluoroscopy and digital subtraction angiography to classify into five grades (best, 0; worst, 4) the severity of vessel calcification according to laterality and length.

According to the researchers, in the study population, 9% (n = 34) had a grade 4 calcification score (bilateral calcification ≥ 5 cm). Those with a grade 4 score had a 2-year primary patency rate of 36.3%, which was a lower rate than those with a score of grade 0 (70%), grade 1 (66.6%), grade 2 (72.1%) or grade 3 (55.6%; P < .001).

When Okuno and colleagues performed a multivariable analysis, they found primary patency loss was associated with PACCS grade 4 (HR = 2.74; 95% CI, 1.56-4.83), diabetes (HR = 1.52; 95% CI, 1.06-2.2), lesion length (HR = 1.04; 95% CI, 1.01-1.07) and vessel diameter (HR = 0.8; 85% CI, 0.65-0.98). Also, a grade 4 calcification score was associated with major adverse limb events (P = .048) and mortality (P = .011).

The researchers wrote that the findings “specifically pertain to the [BMS]” and do not apply to patients who received angioplasty, atherectomy or drug-eluting balloons.

“Worse primary patency was observed in cases with PACSS grade 4 or bilateral wall calcification. We speculated that these features lessened acute gain after angioplasty, resulting in underexpansion of the stent after implantation,” Okuno and colleagues wrote. “In general, stent underexpansion negatively influences long-term results.” – by James Clark

Disclosure: The researchers report no relevant financial disclosures.

Heavy calcification was associated with adverse clinical outcomes such as poor patency and major adverse limb events after endovascular therapy for de novo superficial femoral artery lesions, researchers reported.

Shota Okuno, MD, from Kansai Rosai Hospital Cardiovascular Center in Amagasaki, Hyogo, Japan, and colleagues analyzed data from 394 Japanese patients (mean age, 72 years; 290 men) who had undergone successful endovascular therapy (residual angiographic stenosis < 30%) for de novo superficial femoral artery (SFA) lesions from 2010 to 2013.

Fifty-seven percent (n = 223) of the patients had diabetes and 21% (n = 81) required regular dialysis due to end-stage renal disease. Stents were implanted in 80% (n = 315) of the patients, with 253 (80%) receiving bare-metal stents and 62 (20%) given drug-eluting stents.

The researchers used the peripheral artery calcification scoring system (PACCS), which employs fluoroscopy and digital subtraction angiography to classify into five grades (best, 0; worst, 4) the severity of vessel calcification according to laterality and length.

According to the researchers, in the study population, 9% (n = 34) had a grade 4 calcification score (bilateral calcification ≥ 5 cm). Those with a grade 4 score had a 2-year primary patency rate of 36.3%, which was a lower rate than those with a score of grade 0 (70%), grade 1 (66.6%), grade 2 (72.1%) or grade 3 (55.6%; P < .001).

When Okuno and colleagues performed a multivariable analysis, they found primary patency loss was associated with PACCS grade 4 (HR = 2.74; 95% CI, 1.56-4.83), diabetes (HR = 1.52; 95% CI, 1.06-2.2), lesion length (HR = 1.04; 95% CI, 1.01-1.07) and vessel diameter (HR = 0.8; 85% CI, 0.65-0.98). Also, a grade 4 calcification score was associated with major adverse limb events (P = .048) and mortality (P = .011).

The researchers wrote that the findings “specifically pertain to the [BMS]” and do not apply to patients who received angioplasty, atherectomy or drug-eluting balloons.

“Worse primary patency was observed in cases with PACSS grade 4 or bilateral wall calcification. We speculated that these features lessened acute gain after angioplasty, resulting in underexpansion of the stent after implantation,” Okuno and colleagues wrote. “In general, stent underexpansion negatively influences long-term results.” – by James Clark

Disclosure: The researchers report no relevant financial disclosures.