title: Calcium burden assessment and impact on drug-eluting balloons in peripheral arterial disease.
abstract: OBJECTIVE
  This study was designed to assess the effect of calcium on the efficacy of DEB during revascularization of steno-obstructive SFA lesions.
  
  
  METHODS
  Sixty patients with de novo lesions of the superficial femoral artery underwent endovascular treatment with drug eluting balloons (DEB). DEB was selected according to vessel reference diameter (1:1). In case of residual stenosis > 50 % or flow-limiting dissection, postdilatation with conventional balloon or provisional stenting was done. Patients were classified into eight groups according to circumferential distribution of calcium on CT-angiography axial images (from 0° to 360°) and to its length (length < or > 3 cm) evaluated with digital-subtraction-angiography. Ankle-brachial index (ABI), late lumen loss (LLL), target lesion revascularization (TLR), primary (PP) and secondary (SP) patency, major adverse events (MAE), and Rutherford shift were evaluated at 1-year follow-up and correlated with the amount of calcium.
  
  
  RESULTS
  Revascularization was successful in all cases. Flow-limiting dissection occurred in five cases (8.3 %) with a higher circumferential degree of calcium and solved in three cases with postdilatation and in the other two with provisional stenting. DEB effect was lower in patients with higher degree of calcium (>270° vs. <90°): ABI 0.71 ± 0.07 versus 0.92 ± 0.07; LLL 0.75 ± 0.21 versus 0.45 ± 0.1; PP 50 versus 100 %; SP 50 versus 100 %; TLR 25 versus 0 %; MAE 25 versus 0 %.
  
  
  CONCLUSIONS
  Calcium represents a barrier to optimal drug absorption. Circumferential distribution seems to be the most influencing factor with the worst effect noticed in 360° calcium presence.
authors.affiliation: Vascular and Interventional Radiology Unit, Department of Radiologic Sciences, "Sapienza" University of Rome, 324 Viale Regina Elena, 00161, Rome, Italy, fabrizio.fanelli@uniroma1.it.
authors.forename: F
authors.initials: F
authors.lastname: Fanelli
authors.forename: A
authors.initials: A
authors.lastname: Cannavale
authors.forename: M
authors.initials: M
authors.lastname: Gazzetti
authors.forename: P
authors.initials: P
authors.lastname: Lucatelli
authors.forename: A
authors.initials: A
authors.lastname: Wlderk
authors.forename: C
authors.initials: C
authors.lastname: Cirelli
authors.forename: A
authors.initials: A
authors.lastname: d'Adamo
authors.forename: F M
authors.initials: FM
authors.lastname: Salvatori
mesh_terms: D000368:Aged; D000792:Angiography; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D001157:Arterial Occlusive Diseases / Q000097:blood* / Q000000981:diagnostic imaging / Q000628:therapy*; D002118:Calcium / Q000097:blood*; D004337:Drug Carriers; D057510:Endovascular Procedures; D005260:Female; D005263:Femoral Artery; D006801:Humans; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000097:blood* / Q000000981:diagnostic imaging / Q000628:therapy*; D015607:Stents; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D004337:Drug Carriers; D002118:Calcium