Predicting risk of severe elastic recoil after percutaneous transluminal angioplasty in femoropopliteal artery disease: based on intravascular ultrasound analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Xinyi ¹ , ZOU Yuchi ¹ , TONG Qiang ² , WANG Xuehu ¹ , ZHAO Yu ¹ ,  CHENG Jun ¹

1. Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;
2. Department of Endocrinology, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, P. R. China;

Corresponding author：

CHENG Jun, Email: cqdcj@163.com

Keywords：

femoropopliteal artery; predictve model; intravascular ultrasound; percutaneous transluminal angioplasty; elastic recoil

DOI：

10.7507/1007-9424.202410092

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Objective To identify risk factors for severe elastic recoil after percutaneous transluminal angioplasty (PTA) in the femoropopliteal artery disease basing on intravascular ultrasound (IVUS) imaging and to develop a risk prediction model. Methods A retrospective analysis was conducted on the clinical data from the patients with femoropopliteal artery disease treated at the First Affiliated Hospital of Chongqing Medical University from September 2020 to February 2022. Based on the IVUS images, a multivariate logistic regression analysis was conducted to identify the risk factors for severe elastic recoil in the patients with femoropopliteal artery disease after PTA. A nomogram prediction model was established to predict the occurrence of severe elastic recoil, and the area under receiver operating characteristic curve (AUC) was used to evaluate its ability to distinguish the occurrence of severe elastic recoil, which was validated using a calibration curve. Results A total of 34 patients with femoropopliteal artery disease who received PTA treatment were collected. Of the 803 vessel slices were analyzed, 451 (56.16%) demonstrated severe elastic recoil on IVUS imaging. The patients with preoperative plaque burden, luminal eccentric index, plaque eccentric index, and the external elastic membrane-balloon area ratio were higher, the probability of severe elastic recoil after PTC were higher. The AUC of the nomogram prediction model basing on these risk factors exhibited strong discriminatory [AUC (95%CI)=0.775]. The predicted probability of the nomogram model for severe elastic recoil was in a good agreement with the actual probability (P=0.862). Conclusions The severe elastic recoil prediction model developed in this study, based on IVUS imaging data, can effectively identify high-risk factors for severe elastic recoil following PTA in patients with femoropopliteal artery disease, demonstrating moderate predictive discrimination capability.

1.	Society for Vascular Surgery Lower Extremity Guidelines Writing Group, Conte MS, Pomposelli FB, et al. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg, 2015, 61(3 Suppl): 2S-41S. doi: 10.1016/j.jvs.2014.12.009.
2.	Shammas NW. Restenosis after lower extremity interventions: current status and future directions. J Endovasc Ther, 2009, 16 Suppl 1: I170-I182. doi: 10.1583/08-2564.1.
3.	Aboyans V, Ricco JB, Bartelink MEL, et al. 2022 ESC guidelines on the diagnosis and management of peripheral arterial diseases. Eur Heart J, 2022, 43(15): 1506-1592.
4.	Saucy F, Probst H, Trunfio R. Vessel preparation is essential to optimize endovascular therapy of infrainguinal lesions. Front Cardiovasc Med, 2020, 7: 558129. doi: 10.3389/fcvm.2020.558129.
5.	Purushottam B, Tuma JL, Krishnan P. Commentary: Leave nothing behind: No stent, no restenosis, no mortality. J Endovasc Ther, 2020, 27(5): 706-713.
6.	Torsello G, Stavroulakis K, Brodmann M, et al. Three-year sustained clinical efficacy of drug-coated balloon angioplasty in a real-world femoropopliteal cohort. J Endovasc Ther, 2020, 27(5): 693-705.
7.	Lichaa H. Coronary stent positioning under live IVUS guidance in low contrast percutaneous coronary interventions: The live IVUS stenting technique. Catheter Cardiovasc Interv, 2021, 98(7): E977-E984. doi: 10.1002/ccd.29940.
8.	Miki K, Fujii K, Tanaka T, et al. Impact of IVUS-derived vessel size on midterm outcomes after stent implantation in femoropopliteal lesions. J Endovasc Ther, 2020, 27(1): 77-85.
9.	Miki K, Fujii K, Kawasaki D, et al. Intravascular ultrasound-derived stent dimensions as predictors of angiographic restenosis following nitinol stent implantation in the superficial femoral artery. J Endovasc Ther, 2016, 23(3): 424-432.
10.	Pliagas G, Saab F, Stavroulakis K, et al. Intravascular ultrasound imaging versus digital subtraction angiography in patients with peripheral vascular disease. J Invasive Cardiol, 2020, 32(3): 99-103.
11.	Iida O, Takahara M, Soga Y, et al. Vessel diameter evaluated by intravascular ultrasound versus angiography. J Endovasc Ther, 2022, 29(3): 343-349.
12.	Mori S, Hirano K, Takahara M, et al. Accuracy of quantitative vessel analysis in endovascular treatment for femoropopliteal lesions. Quant Imaging Med Surg, 2022, 12(1): 568-575.
13.	Liu Z, He Z, Liu Y, et al. Predictive value of intravascular ultrasound in long-term outcomes after femoropopliteal balloon angioplasty. J Endovasc Ther, 2020, 27(6): 733-740.
14.	Torsello G, Stavroulakis K, Brodmann M, et al. Intravascular ultrasound for predicting outcomes in femoropopliteal angioplasty and stenting. J Endovasc Ther, 2021, 28(4): 526-535.
15.	Kurata N, Iida O, Shiraki T, et al. Impact of stent-to-vessel diameter ratio on restenosis in the superficial femoral artery after endovascular therapy. Circ J, 2018, 82(5): 1412-1417.
16.	Min HS, Ryu D, Kang SJ, et al. Prediction of coronary stent underexpansion by pre-procedural intravascular ultrasound-based deep learning. JACC Cardiovasc Interv, 2021, 14(9): 1021-1029.
17.	Zhao Y, Yang H, Lin Y, et al. Clinical outcomes of the treatment of peripheral arterial disease using drug-eluting balloons in patients with critical limb ischemia. J Vasc Surg. 2020;71(4): 1345-1354.
18.	Kurata N, Iida O, Takahara M, et al. Clinical impact of the size of drug-coated balloon therapy on restenosis rate in femoropopliteal lesions. J Endovasc Ther, 2023, 30(2): 269-280.
19.	Finn MT, Ingrassia JJ, Parikh SA. Plaque modification in endovascular procedures in patients with infrainguinal disease. Interv Cardiol Clin, 2020, 9(2): 125-137.
20.	Sharma S, Jaff MR, Perkins E, et al. Clinical outcomes following intravascular ultrasound-guided femoropopliteal angioplasty: A 5-year follow-up study. J Am Coll Cardiol, 2021, 77(8): 981-988.

1. Society for Vascular Surgery Lower Extremity Guidelines Writing Group, Conte MS, Pomposelli FB, et al. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg, 2015, 61(3 Suppl): 2S-41S. doi: 10.1016/j.jvs.2014.12.009.
2. Shammas NW. Restenosis after lower extremity interventions: current status and future directions. J Endovasc Ther, 2009, 16 Suppl 1: I170-I182. doi: 10.1583/08-2564.1.
3. Aboyans V, Ricco JB, Bartelink MEL, et al. 2022 ESC guidelines on the diagnosis and management of peripheral arterial diseases. Eur Heart J, 2022, 43(15): 1506-1592.
4. Saucy F, Probst H, Trunfio R. Vessel preparation is essential to optimize endovascular therapy of infrainguinal lesions. Front Cardiovasc Med, 2020, 7: 558129. doi: 10.3389/fcvm.2020.558129.
5. Purushottam B, Tuma JL, Krishnan P. Commentary: Leave nothing behind: No stent, no restenosis, no mortality. J Endovasc Ther, 2020, 27(5): 706-713.
6. Torsello G, Stavroulakis K, Brodmann M, et al. Three-year sustained clinical efficacy of drug-coated balloon angioplasty in a real-world femoropopliteal cohort. J Endovasc Ther, 2020, 27(5): 693-705.
7. Lichaa H. Coronary stent positioning under live IVUS guidance in low contrast percutaneous coronary interventions: The live IVUS stenting technique. Catheter Cardiovasc Interv, 2021, 98(7): E977-E984. doi: 10.1002/ccd.29940.
8. Miki K, Fujii K, Tanaka T, et al. Impact of IVUS-derived vessel size on midterm outcomes after stent implantation in femoropopliteal lesions. J Endovasc Ther, 2020, 27(1): 77-85.
9. Miki K, Fujii K, Kawasaki D, et al. Intravascular ultrasound-derived stent dimensions as predictors of angiographic restenosis following nitinol stent implantation in the superficial femoral artery. J Endovasc Ther, 2016, 23(3): 424-432.
10. Pliagas G, Saab F, Stavroulakis K, et al. Intravascular ultrasound imaging versus digital subtraction angiography in patients with peripheral vascular disease. J Invasive Cardiol, 2020, 32(3): 99-103.
11. Iida O, Takahara M, Soga Y, et al. Vessel diameter evaluated by intravascular ultrasound versus angiography. J Endovasc Ther, 2022, 29(3): 343-349.
12. Mori S, Hirano K, Takahara M, et al. Accuracy of quantitative vessel analysis in endovascular treatment for femoropopliteal lesions. Quant Imaging Med Surg, 2022, 12(1): 568-575.
13. Liu Z, He Z, Liu Y, et al. Predictive value of intravascular ultrasound in long-term outcomes after femoropopliteal balloon angioplasty. J Endovasc Ther, 2020, 27(6): 733-740.
14. Torsello G, Stavroulakis K, Brodmann M, et al. Intravascular ultrasound for predicting outcomes in femoropopliteal angioplasty and stenting. J Endovasc Ther, 2021, 28(4): 526-535.
15. Kurata N, Iida O, Shiraki T, et al. Impact of stent-to-vessel diameter ratio on restenosis in the superficial femoral artery after endovascular therapy. Circ J, 2018, 82(5): 1412-1417.
16. Min HS, Ryu D, Kang SJ, et al. Prediction of coronary stent underexpansion by pre-procedural intravascular ultrasound-based deep learning. JACC Cardiovasc Interv, 2021, 14(9): 1021-1029.
17. Zhao Y, Yang H, Lin Y, et al. Clinical outcomes of the treatment of peripheral arterial disease using drug-eluting balloons in patients with critical limb ischemia. J Vasc Surg. 2020;71(4): 1345-1354.
18. Kurata N, Iida O, Takahara M, et al. Clinical impact of the size of drug-coated balloon therapy on restenosis rate in femoropopliteal lesions. J Endovasc Ther, 2023, 30(2): 269-280.
19. Finn MT, Ingrassia JJ, Parikh SA. Plaque modification in endovascular procedures in patients with infrainguinal disease. Interv Cardiol Clin, 2020, 9(2): 125-137.
20. Sharma S, Jaff MR, Perkins E, et al. Clinical outcomes following intravascular ultrasound-guided femoropopliteal angioplasty: A 5-year follow-up study. J Am Coll Cardiol, 2021, 77(8): 981-988.

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