title: String-like lumen in below-the-knee chronic total occlusions on contrast-enhanced magnetic resonance angiography predicts intraluminal recanalization and better blood flow restoration.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  In patients with BTK CTOs, SL predicted intraluminal angioplasty and good blood-flow restoration for BTK CTOs.
  
  
  CONCLUSIONS
  • 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.
authors: Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai, 200233, China.
authors: Yue-Qi
authors: YQ
authors: Zhu
authors: Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai, 200233, China.
authors: Hai-Tao
authors: HT
authors: Lu
authors: Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai, 200233, China.
authors: Li-Ming
authors: LM
authors: Wei
authors: Department of Endocrinology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai, 200233, China.
authors: Fang
authors: F
authors: Liu
authors: Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai, 200233, China.
authors: Ying-Sheng
authors: YS
authors: Cheng
authors: Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai, 200233, China.
authors: Jian-Bo
authors: JB
authors: Wang
authors: Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yi Shan Road, Shanghai, 200233, China. zhaojungongradio@hotmail.com.
authors: Jun-Gong
authors: JG
authors: Zhao
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D001783:Blood Flow Velocity / Q000502:physiology*; D003287:Contrast Media / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007717:Knee; D023821:Limb Salvage / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D012039:Regional Blood Flow / Q000502:physiology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: Angioplasty; Below the knee; Critical limb ischaemia; Diabetes; Runoff