Optimal Vessel Sizing and Understanding Dissections in Infrapopliteal Interventions: Data From the iDissection Below
Nicolas W Shammas1, W John Shammas1, Susan Jones-Miller1
1Midwest Cardiovascular Research Foundation, Davenport, IA, USA.
Summary
Intravascular ultrasound (IVUS) provides more accurate infrapopliteal vessel diameter measurements and detects more dissections than angiography after intervention. Angiography underestimates vessel size and misses significant post-intervention dissections compared to IVUS.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Imaging
Background:
- Infrapopliteal artery disease affects numerous patients, often requiring endovascular intervention.
- Accurate assessment of vessel size and post-intervention complications like dissections is crucial for optimal outcomes.
- Conventional angiography may not fully capture the extent of these issues.
Purpose of the Study:
- To compare the accuracy of intravascular ultrasound (IVUS) against quantitative vascular angiography (QVA) for assessing infrapopliteal vessel diameter post-intervention.
- To evaluate the ability of IVUS to detect dissections compared to angiography following percutaneous transluminal angioplasty (PTA) and/or orbital atherectomy (OA).
Main Methods:
- A prospective study of 20 patients with infrapopliteal disease undergoing PTA or OA followed by PTA.
- Vessel diameters measured by IVUS (internal elastic lamina to IEL) and QVA.
- Dissections categorized using National Heart Lung and Blood Institute (NHLBI) criteria for angiography and arc/depth for IVUS.
Main Results:
- IVUS showed significantly larger mean vessel diameters (4.0 mm) compared to QVA (2.9 mm) (p<0.001).
- IVUS identified 3.8 times more dissections than angiography, with significant differences in detection rates after PTA and OA+PTA.
- Bailout stenting was required in 6 patients after PTA due to angiographic dissections, but none in the OA+PTA group.
Conclusions:
- Angiography underestimates infrapopliteal vessel diameter by approximately 25% compared to IVUS.
- IVUS is superior to angiography in detecting the presence and severity of post-intervention dissections in infrapopliteal arteries.
- These findings highlight the value of IVUS for comprehensive assessment and management of complex infrapopliteal interventions.
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