scholarly journals Diffusion as a Natural Contrast in MR Imaging of Peripheral Artery Disease (PAD) Tissue Changes. A Case Study of the Clinical Application of DTI for a Patient with Chronic Calf Muscles Ischemia

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 92
Author(s):  
Weronika Mazur ◽  
Małgorzata Urbańczyk-Zawadzka ◽  
Robert Banyś ◽  
Rafał Obuchowicz ◽  
Mariusz Trystuła ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Diffusion Tensor ◽  
Peripheral Circulation ◽  
Significant Loss ◽  
Arterial Stenosis ◽  
Peripheral Artery ◽  
Double Blind ◽  
Distribution Method ◽  
Artery Disease ◽  
Calf Muscles

This paper reports a first application of diffusion tensor imaging with corrections by using the B-matrix spatial distribution method (BSD-DTI) for peripheral artery disease (PAD) detected in the changes of diffusion tensor parameters (DTPs). A 76-year-old male was diagnosed as having PAD, since he demonstrated in angiographic images of lower legs severe arterial stenosis and the presence of lateral and peripheral circulation and assigned to the double-blind RCT using mesenchymal stem cells (MSCs) or placebo for the regenerative treatment of implications of ischemic diseases. In order to indicate changes in diffusivity in calf muscles in comparison to a healthy control, a DTI methodology was developed. The main advantage of the applied protocol was decreased scanning time, which was achieved by reducing b-value and number of scans (to 1), while maintaining minimal number of diffusion gradient directions and high resolution. This was possible due to calibration via the BSD method, which reduced systematic errors and allowed quantitative analysis. In the course of PAD, diffusivities were elevated across the calf muscles in posterior compartment and lost their anisotropy. Different character was noticed for anterior compartment, in which diffusivities along and across muscles were decreased without a significant loss of anisotropy. After the intervention involving a series of injections, the improvement of DTPs and tractography was visible, but can be assigned neither to MSCs nor placebo before unblinding.

Abstract 075: Heterogeneity in Treatment Effect in Patients With Peripheral Artery Disease: Insights From the CLEVER Trial

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Yashashwi Pokharel ◽  
Phillip Jones ◽  
Garth Graham ◽  
John Spertus ◽  
Kim Smolderen
Keyword(s):  
Peripheral Artery Disease ◽  
Significant Interaction ◽  
Treatment Time ◽  
Demographic Factors ◽  
Arterial Stenosis ◽  
Treatment Modalities ◽  
Peripheral Artery ◽  
Supervised Exercise ◽  
Maximum Likelihood Methods ◽  
Artery Disease

Background: The CLEVER trial (Claudication: Exercise versus Endoluminal Revascularization) showed significant improvement in peripheral artery disease (PAD)-specific health status (Peripheral Artery Questionnaire, PAQ) at 6 and 18 months for both supervised exercise (SE) and stent therapy (ST) compared with optimal medical care (OMC) in PAD patients. However, it is unknown whether there is variation in treatment by age, gender or race, or if recovery is similar across these groups over time. Methods: A total of 111 patients from 22 sites with hemodynamically significant aortoiliac arterial stenosis were randomized to SE, ST, or OMC. Using maximum likelihood methods for longitudinal analyses, we analyzed change from baseline in PAQ summary scores at 6 and 18 months and tested interactions between demographic factors (≥65 vs. <65 years; women vs. men; non-Caucasians vs. Caucasians) and treatment, time, and treatment by time. When significant, we further examined effects by different treatment modalities (OMC, SE and ST). Results: The mean age of the study population was 64.4 years (53.1% <65 years), 37.8% were women and 32.4% were non-Caucasians (26.1% African Americans and 6.3% other race). There was a significant interaction by race and treatment (p=0.006, overall difference in PAQ summary scores in non-Caucasians minus Caucasians -4.0 [-11.6, 3.6], p=0.30), but there was no significant interaction between other demographic factors and treatment, time, or treatment and time. In Caucasians, PAQ summary scores improved only with ST; in non-Caucasians, improvement was similar with ST or SE (Figure). Estimates of difference in PAQ scores between SE or ST and OMC showed similar results (Table). Conclusion: There was a significant interaction between treatment and race, with only ST showing significant improvement in PAQ scores in Caucasians, whereas both ST and SE showed significant improvements in PAQ among non-Caucasians. Further studies should validate and explore the mechanisms of different racial responses to PAD treatment.

Abstract 17377: Quantification of Arterial Stenosis Severity Based on the Changes in the Perfusion Wave Dynamics; a Novel Technology for Monitoring Peripheral Artery Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tomer Heitner ◽  
Amit Livneh ◽  
Jonathan Lorber ◽  
Ron Karmeli ◽  
Amir Landesberg
Keyword(s):  
Early Detection ◽  
Peripheral Artery Disease ◽  
Unmet Need ◽  
The Elderly ◽  
Arterial Stenosis ◽  
Slow Phase ◽  
Peripheral Artery ◽  
Phase Duration ◽  
Stenosis Severity ◽  
Artery Disease

Introduction: Current screening modalities for peripheral artery disease (PAD) lack sensitivity especially in the elderly and diabetics, and there is an unmet need for early detection of restenosis after revascularization. Hypothesis: We have hypothesized that arterial stenosis is associated with adaptive arteriolar vasodilatation, which alters the downstream perfusion dynamics and prolongs the initial phase of the perfusion upstroke. These changes can be utilized for quantification of the arterial stenosis severity. Methods: We measured the lower leg perfusion with impedance plethysmography and compared it with other modalities used in the clinic and the gold-standard angiography. The various phases of the perfusion wave were identified by analyzing the first and second derivatives of the plethysmography. The signals were acquired from PAD patients before and after they underwent revascularization, to validate the ability to detect stenosis and successful revascularization. Results: Eighteen consenting patients were recruited (61±10 years old) and nineteen legs were treated. The perfusion upstroke encompasses 2 or 3 distinctive phases. An initial slow phase that is followed by a brisk upstroke and a final sallower augmentation in some patients. The slow phase duration (SPd) was 113±45 ms in extremities with above-knee (AK) arterial stenosis (n=17) while significantly shorter SPd of 26±0 ms was observed in limbs without AK stenoses (P = 0.011). In the AK extremities, the SPd significantly decreased to 52±40 ms after successful revascularization (P<0.01). Moreover, in AK cases with a satisfactory post-operative result (Duplex assessment), the SPd dramatically decreased from 103±35 ms before revascularization to 35±18 ms afterward (P<0.01, n=12). Conclusions: Analysis of the perfusion dynamic provides a gamut of precious indices. The SPd is a novel index that can detect and quantify the severity of arterial stenosis. The technology can significantly improve the surveillance of PAD patients and may be used for early detection of restenosis.

scholarly journals Risk factors and clinical outcomes in chronic coronary and peripheral artery disease: An analysis of the randomized, double-blind COMPASS trial

2019 ◽  
Vol 27 (3) ◽  
pp. 296-307 ◽  
Author(s):  
Thomas Vanassche ◽  
Peter Verhamme ◽  
Sonia S Anand ◽  
Olga Shestakovska ◽  
Keith AA Fox ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Peripheral Artery Disease ◽  
Low Dose ◽  
Cardiovascular Death ◽  
Peripheral Artery ◽  
Double Blind ◽  
Artery Disease ◽  
Risk Factor Status ◽  
Ischemic Events

Aims Secondary prevention in patients with coronary artery disease and peripheral artery disease involves antithrombotic therapy and optimal control of cardiovascular risk factors. In the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) study, adding low-dose rivaroxaban on top of aspirin lowered cardiovascular events, but there is limited data about risk factor control in secondary prevention. We studied the association between risk factor status and outcomes, and the impact of risk factor status on the treatment effect of rivaroxaban, in a large contemporary population of patients with coronary artery disease or peripheral artery disease. Methods and results We reported ischemic events (cardiovascular death, stroke, or myocardial infarction) in participants from the randomized, double-blind COMPASS study by individual risk factor (blood pressure, smoking status, cholesterol level, presence of diabetes, body mass index, and level of physical activity), and by number of risk factors. We compared rates and hazard ratios of patients treated with rivaroxaban plus aspirin vs aspirin alone within each risk factor category and tested for interaction between risk factor status and antithrombotic regimen. Complete baseline risk factor status was available in 27,117 (99%) patients. Status and number of risk factors were both associated with increased risk of ischemic events. Rates of ischemic events (hazard ratio 2.2; 95% confidence interval 1.8–2.6) and cardiovascular death (hazard ratio 2.0; 1.5–2.7) were more than twofold higher in patients with 4–6 compared with 0–1 risk factors ( p < 0.0001 for both). Rivaroxaban reduced event rates independently of the number of risk factors ( p interaction 0.93), with the largest absolute benefit in patients with the highest number of risk factors. Conclusion More favorable risk factor status and low-dose rivaroxaban were independently associated with lower risk of cardiovascular events.

scholarly journals Dynamic characteristics of T2*-weighted signal in calf muscles of peripheral artery disease during low-intensity exercise

2016 ◽  
Vol 46 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Zhijun Li ◽  
Matthew D. Muller ◽  
Jianli Wang ◽  
Christopher T. Sica ◽  
Prasanna Karunanayaka ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Dynamic Characteristics ◽  
Peripheral Artery ◽  
Low Intensity ◽  
Artery Disease ◽  
Low Intensity Exercise ◽  
Calf Muscles

Abstract 16894: The Effect of Cangrelor on Cardiovascular and Bleeding Events in Patients With Peripheral Artery Disease - Insights From CHAMPION PHOENIX

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Antonio Gutierrez ◽  
Robert A Harrington ◽  
Gregg W Stone ◽  
Ph. G Steg ◽  
Michael C Gibson ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Primary Endpoint ◽  
Prior History ◽  
Severe Bleeding ◽  
Peripheral Artery ◽  
Bleeding Events ◽  
Double Blind ◽  
Life Threatening ◽  
Artery Disease ◽  
Ischemic Events

Background: Patients with peripheral artery disease (PAD) are high risk for adverse cardiovascular and bleeding events. In CHAMPION-PHOENIX, cangrelor, an intravenous P2Y12 inhibitor, reduced rates of ischemic events in patients undergoing PCI. Hypothesis: We hypothesize that cangrelor will safely reduce ischemic events in patients with PAD undergoing PCI. Methods: A total of 11,145 patients were randomly assigned in a double-dummy, double-blind manner to either cangrelor followed by clopidogrel 600 mg or to clopidogrel loading at PCI. The primary endpoint was a composite of death, MI, ischemia-driven revascularization (IDR), or stent thrombosis (ST) at 48 hours. Results: 837 (8%) patients with PAD and 9,994 (90%) patients with no prior history of PAD underwent PCI. Among the PAD cohort the primary endpoint occurred in 20 (4.5%) cangrelor vs. 44 (11.4%) clopidogrel patients (OR [95% CI] = 0.36 [0.21, 0.63]), and 235 (4.7%) cangrelor vs. 276 (5.5%) clopidogrel patients (OR [95%CI] = 0.86 [0.72, 1.03]) without PAD (p for interaction = 0.003). Among the PAD cohort the rate of GUSTO severe/life-threatening bleeding was 0.4% cangrelor vs. 0% clopidogrel (p = 0.19), and 0.1% cangrelor vs. 0.1% clopidogrel patients (OR [95%CI] = 1.78 [0.52, 6.07], p = 0.35) without PAD (p for interaction = 0.34). The rate of blood transfusion in the PAD cohort was 0.9% cangrelor vs. 0% clopidogrel (p = 0.06), and 0.4% cangrelor vs. 0.3% clopidogrel patients (OR [95%CI] = 1.42 [0.73, 2.76], p = 0.30) without PAD (p for interaction = 0.13). Conclusion: In CHAMPION-PHOENIX, cangrelor significantly reduced ischemic events with no significant increase in severe bleeding or transfusions in patients with PAD.

scholarly journals Does Creatine Supplementation Affect Renal Function in Patients with Peripheral Artery Disease? A Randomized, Double Blind, Placebo-controlled, Clinical Trial

2020 ◽  
Vol 63 ◽  
pp. 45-52 ◽  
Author(s):  
Wagner Jorge Ribeiro Domingues ◽  
Raphael Mendes Ritti-Dias ◽  
Gabriel Grizzo Cucato ◽  
Nelson Wolosker ◽  
Antonio Eduardo Zerati ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Renal Function ◽  
Peripheral Artery Disease ◽  
Creatine Supplementation ◽  
Controlled Clinical Trial ◽  
Peripheral Artery ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Artery Disease

scholarly journals Ankle brachial index as a surrogate to vascular imaging in evaluation of peripheral artery disease in patients with type 2 diabetes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ejiofor Ugwu ◽  
Anthony Anyanwu ◽  
Michael Olamoyegun
Keyword(s):  
Type 2 Diabetes ◽  
Peripheral Artery Disease ◽  
Ankle Brachial Index ◽  
Invasive Procedure ◽  
Arterial Stenosis ◽  
Peripheral Artery ◽  
Good Reliability ◽  
Cardiovascular Morbidity And Mortality ◽  
Artery Disease

Abstract Background Peripheral artery disease (PAD) is common in persons with type 2 diabetes (T2DM) and contributes significantly to cardiovascular morbidity and mortality. Controversy exists regarding the utility of ankle brachial index (ABI) for clinical diagnosis of PAD in persons with diabetes. The aim of this study was to evaluate the reliability of ABI for diagnosis of PAD in patients with T2DM using duplex ultrasonography (DUS) as the gold standard. Results A total of 319 legs from 163 patients comprising of 156 subjects with intact legs and 7 patients who had undergone unilateral lower limb amputations were studied. The mean age of the participants was 56.1 ± 17.3 years. One hundred and ninety-five legs (61.1%) had sonographically confirmed PAD which was mild, moderate and severe in 40%, 41.5% and 18.5% respectively. The accuracy of ABI in detecting PAD was 76.7% for mild stenosis, 91.7% for moderate stenosis and 93.1% for severe stenosis. The sensitivity of ABI improved with increasing severity of arterial stenosis, reaching 100% in severe cases. ABI demonstrated good agreement with DUS [kappa = 0.65 (95% CI 0.49–0.88), P < 0.001]. Conclusion In comparison to DUS, the ABI demonstrated good reliability for diagnosis of PAD in high risk T2DM patients. The utility of this simple and non-invasive procedure should therefore be maximized in clinical practice.

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