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

Research output: Contribution to journalJournal articleResearchpeer-review

  • Mohammed M Chowdhury
  • Jason M Tarkin
  • Mazen S Albaghdadi
  • Nicholas R Evans
  • Elizabeth P V Le
  • Thomas B Berrett
  • Umar Sadat
  • Francis R Joshi
  • Elizabeth A Warburton
  • John R Buscombe
  • Paul D Hayes
  • Marc R Dweck
  • David E Newby
  • James H F Rudd
  • Patrick A Coughlin
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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.

Original languageEnglish
JournalJACC. Cardiovascular imaging
Issue number4
Pages (from-to)1008-1017
Number of pages10
Publication statusPublished - Apr 2020

Bibliographical note

Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

    Research areas

  • F-fluorodeoxyglucose, F-sodium fluoride, atherosclerosis, computed tomography, peripheral arterial disease, positron emission tomography, restenosis

ID: 59127186