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Vascular Positron Emission Tomography and Restenosis in Symptomatic Peripheral Arterial Disease: A Prospective Clinical Study.

Accepted version
Peer-reviewed

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Article

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Authors

Chowdhury, Mohammed M 
Tarkin, Jason M 
Albaghdadi, Mazen S 
Evans, Nicholas R 
Le, Elizabeth PV 

Abstract

OBJECTIVES: This study determined whether in vivo positron emission tomography (PET) of arterial inflammation (18F-fluorodeoxyglucose [18F-FDG]) or microcalcification (18F-sodium fluoride [18F-NaF]) could predict restenosis following PTA. BACKGROUND: Restenosis following lower limb percutaneous transluminal angioplasty (PTA) is common, unpredictable, and challenging to treat. Currently, it is impossible to predict which patient will suffer from restenosis following angioplasty. METHODS: In this prospective observational cohort study, 50 patients with symptomatic peripheral arterial disease underwent 18F-FDG and 18F-NaF PET/computed tomography (CT) imaging of the superficial femoral artery before and 6 weeks after angioplasty. The primary outcome was arterial restenosis at 12 months. RESULTS: Forty subjects completed the study protocol with 14 patients (35%) reaching the primary outcome of restenosis. The baseline activities of femoral arterial inflammation (18F-FDG tissue-to-background ratio [TBR] 2.43 [interquartile range (IQR): 2.29 to 2.61] vs. 1.63 [IQR: 1.52 to 1.78]; p < 0.001) and microcalcification (18F-NaF TBR 2.61 [IQR: 2.50 to 2.77] vs. 1.69 [IQR: 1.54 to 1.77]; p < 0.001) were higher in patients who developed restenosis. The predictive value of both 18F-FDG (cut-off TBRmax value of 1.98) and 18F-NaF (cut-off TBRmax value of 2.11) uptake demonstrated excellent discrimination in predicting 1-year restenosis (Kaplan Meier estimator, log-rank p < 0.001). CONCLUSIONS: Baseline and persistent femoral arterial inflammation and micro-calcification are associated with restenosis following lower limb PTA. For the first time, we describe a method of identifying complex metabolically active plaques and patients at risk of restenosis that has the potential to select patients for intervention and to serve as a biomarker to test novel interventions to prevent restenosis.

Description

Keywords

(18)F-fluorodeoxyglucose, (18)F-sodium fluoride, atherosclerosis, computed tomography, peripheral arterial disease, positron emission tomography, restenosis, Aged, Aged, 80 and over, Angioplasty, Balloon, Female, Femoral Artery, Fluorodeoxyglucose F18, Humans, Male, Middle Aged, Peripheral Arterial Disease, Plaque, Atherosclerotic, Positron-Emission Tomography, Predictive Value of Tests, Prospective Studies, Radiopharmaceuticals, Recurrence, Risk Factors, Sodium Fluoride, Time Factors, Treatment Outcome

Journal Title

JACC Cardiovasc Imaging

Conference Name

Journal ISSN

1936-878X
1876-7591

Volume Title

13

Publisher

Elsevier BV
Sponsorship
British Heart Foundation (None)
Academy of Medical Sciences (unknown)
British Heart Foundation (None)
Evelyn Trust (unknown)
Wellcome Trust (104492/Z/14/Z)
Engineering and Physical Sciences Research Council (EP/N014588/1)
Cambridge University Hospitals NHS Foundation Trust (CUH) (unknown)
Wellcome Trust (211100/Z/18/Z)
British Heart Foundation (FS/16/29/31957)
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
Medical Research Council (1966157)
The Dunhill Medical Trust (None)
Engineering and Physical Sciences Research Council (EP/N031938/1)