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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
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Evaluating Calcification in Below-the-Knee Lesions Using Adjusted Computed Tomography Window Settings.

Dai Ozaki1, Tetsuro Miyazaki1, Hiroshi Abe1

  • 1Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan.

Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists
|November 26, 2025
PubMed
Summary

True full-moon calcifications are linked to lower procedural success rates in below-the-knee endovascular therapy and chronic total occlusion cases. Noncontrast CT with artifact reduction can help identify these challenging lesions for better treatment planning.

Keywords:
below-the-knee lesionfull-moon calcificationguidewire crossingnoncontrast computed tomographyperipheral artery disease

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Area of Science:

  • Vascular Medicine
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Severe calcification poses challenges in below-the-knee endovascular therapy (BTK EVT).
  • Computed tomography (CT) artifacts can hinder accurate assessment of calcified plaques.
  • Noncontrast CT with adjusted window settings may improve plaque evaluation.

Purpose of the Study:

  • To assess true full-moon calcifications in tibial and peroneal arteries.
  • To determine the impact of these calcifications on procedural success in BTK EVT.
  • To evaluate their effect on antegrade guidewire success in chronic total occlusion (CTO) cases.

Main Methods:

  • Retrospective analysis of 103 vessels from 58 patients using noncontrast CT.
  • Definition of full-moon calcifications as plaques occupying >80% of the cross-sectional area.
  • Classification of true full-moon calcifications after artifact reduction and comparison between successful and failed procedures.

Main Results:

  • True full-moon calcifications were significantly higher in procedural failure groups (22.81%) versus success groups (1.87%).
  • Antegrade guidewire success in CTO cases was lower with higher true full-moon calcifications (13.95% vs 0.00%).
  • Diabetes, lesion length, CTO, and true full-moon calcifications independently predicted lower procedural success.

Conclusions:

  • True full-moon calcifications are significant predictors of procedural failure in BTK EVT and CTO interventions.
  • Noncontrast CT with artifact reduction aids in assessing these challenging lesions for procedural planning.
  • Identifying true full-moon calcifications can guide strategy optimization and improve outcomes in complex peripheral interventions.