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(Circulation. 2002;106:1570.)
© 2002 American Heart Association, Inc.

Images in Cardiovascular Medicine

Effect of Percutaneous Transluminal Angioplasty on Severely Stenotic Femoral Lesions

In Vivo Demonstration by Noninvasive Magnetic Resonance Imaging

Roberto Corti, MD^*; Rolf Wyttenbach, MD^*; Mario Alerci, MD; Juan J Badimon, PhD; Valentin Fuster, MD, PhD; Augusto Gallino, MD

Cardiovascular Institute, Mount Sinai School of Medicine (R.C., J.J.B., V.F.), New York, NY, and Ospedale San Giovanni, Bellinzona (R.W., M.A., A.G.), Switzerland.

Correspondence to Prof Augusto Gallino, MD, Division of Cardiovascular Medicine, Ospedale San Giovanni, 6500 Bellinzona, Switzerland. E-mail agallino{at}bluewin.ch

The angiogram of a 68-year-old woman with severe claudication (Rutherford clinical class 3) of the right leg revealed a chronic high-grade preocclusive stenosis of the distal superficial femoral artery, with multiple collateral vessels (Figure 1A). Post-percutaneous transluminal angioplasty (PTA) angiography demonstrated restoration of both lumen and antegrade flow (Figure 1B). Cross-sectional magnetic resonance (MR) imaging performed 24 hours after PTA at the level of the arterial occlusion (Figure 2) revealed severe disruption and splitting of the atherosclerotic plaque, resulting in an irregularly shaped lumen. Angiographic and MR images were clearly discrepant, with angiography underestimating the residual lesion. The arrow in Figure 2F mimics the angio- graphic projection and explains why the angiography overestimated the result of the PTA.

View larger version (131K): [in this window] [in a new window]   Figure 1. Angiography pre- and post-PTA of the right leg. PTA was performed in the distal superficial femoral artery (SFA) at the level of Hunter’s channel.

View larger version (137K): [in this window] [in a new window]   Figure 2. Axial, proton-density weighted high-resolution MR images of the right leg at the level of the superficial femoral artery, showing chronic high-grade preocclusive stenosis (or partially recanalized chronic occlusion) pre-PTA (A, detail C) and post-PTA (B, detail D. The residual lumen is highlighted in red in the details pictures (C and D). The arrows mimic the projection normally used in x-ray diagnostic.

This case provides in vivo evidence of extensive plaque disruption induced by balloon angioplasty, and may explain mechanisms of complications of this technique. Once such mechanisms such as thrombus formation are identified, targeted therapies can be more effectively chosen. In addition, it highlights the potential overestimation of PTA results by X-ray angiography as it underestimates the residual plaque size. Therefore, cross-sectional analysis by MR imaging could be useful in follow-up to define plaque remodeling and, perhaps, to identify prognostic factors for restenosis (eg, plaque splitting).

Footnotes

*Drs Corti and Wyttenbach contributed equally to this article.

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Corti, R. Articles by Gallino, A. Search for Related Content PubMed PubMed Citation Articles by Corti, R. Articles by Gallino, A. Related Collections Catheter-based coronary and valvular interventions: other CT and MRI Other imaging