title: Invasive evaluation of plaque morphology of symptomatic superficial femoral artery stenoses using combined near-infrared spectroscopy and intravascular ultrasound.
abstract: The purpose of this study is to characterize the plaque morphology of severe stenoses in the superficial femoral artery (SFA) employing combined near-infrared spectroscopy and intravascular ultrasound (NIRS-IVUS). Atherosclerosis is the most common cause of symptomatic peripheral arterial disease. Plaque composition of SFA stenoses has been characterized as primarily fibrous or fibrocalcific by non-invasive and autopsy studies. NIRS has been validated to detect lipid-core plaque (LCP) in the coronary circulation. We imaged severe SFA stenoses with NIRS-IVUS prior to revascularization in 31 patients (46 stenoses) with Rutherford claudication ⩾ class 3. Angiographic parameters included lesion location and stenosis severity. IVUS parameters included plaque burden and presence of calcium. NIRS images were analyzed for LCP and maximum lipid-core burden index in a 4-mm length of artery (maxLCBI4mm). By angiography, 38 (82.6%) lesions were calcified and 9 (19.6%) were chronic total occlusions. Baseline stenosis severity and lesion length were 86.0 ± 11.0% and 36.5 ± 46.5 mm, respectively. NIRS-IVUS identified calcium in 45 (97.8%) lesions and LCP in 17 (37.0%) lesions. MaxLCBI4mm was 433 ± 244. All lesions with LCP also contained calcium; there were no non-calcified lesions with LCP. In conclusion, this is the first study of combined NIRS-IVUS in patients with PAD. NIRS-IVUS demonstrates that nearly all patients with symptomatic severe SFA disease have fibrocalcific plaque, and one-third of such lesions contain LCP. These findings contrast with those in patients with acute coronary syndromes, and may have implications regarding the pathophysiology of atherosclerosis in different vascular beds.
authors.affiliation: Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, MI, USA.
authors.forename: Sibin K
authors.initials: SK
authors.lastname: Zacharias
authors.affiliation: Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, MI, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Safian
authors.affiliation: Frederick Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI, USA.
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Madder
authors.affiliation: Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, MI, USA.
authors.forename: Ivan D
authors.initials: ID
authors.lastname: Hanson
authors.affiliation: Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, MI, USA.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Pica
authors.affiliation: Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, MI, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Smith
authors.affiliation: Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, MI, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Goldstein
authors.affiliation: Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, MI, USA amr.abbas@beaumont.org.
authors.forename: Amr E
authors.initials: AE
authors.lastname: Abbas
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D003251:Constriction, Pathologic; D005260:Female; D005263:Femoral Artery / Q000737:chemistry / Q000000981:diagnostic imaging* / Q000473:pathology; D005355:Fibrosis; D006801:Humans; D008055:Lipids / Q000032:analysis; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D019265:Spectroscopy, Near-Infrared; D018084:Ultrasonography, Interventional; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D008055:Lipids
keywords: arterial occlusive diseases; claudication; intermittent claudication; intravascular ultrasonography; lower extremity; near-infrared spectroscopy; peripheral arterial disease; stenosis; stents; superficial femoral artery