Peripheral interventions

Intravascular imaging and histological correlates of medial and intimal calcification in peripheral artery disease

EuroIntervention 2021;17:e688-e698. DOI: 10.4244/EIJ-D-20-01336

Hiroyuki Jinnouchi
Hiroyuki Jinnouchi1, MD; Yu Sato1, MD; Rahul R. Bhoite1, MD; Salome H. Kuntz1, MD; Atsushi Sakamoto1, MD; Matthew Kutyna1, PhD; Sho Torii1, MD; Masayuki Mori1, MD; Rika Kawakami1, MD; Falone C. Amoa1, MD; Frank D. Kolodgie1, PhD; Renu Virmani1, MD; Aloke V. Finn1,2, MD
1. CVPath Institute, Gaithersburg, MD, USA; 2. University of Maryland, Baltimore, MD, USA

Background: In peripheral artery disease, two different types of calcification are frequently observed, i.e., medial and intimal calcification.

Aims: The aim of this study was to determine the ability of intravascular ultrasound (IVUS) imaging and optical frequency domain imaging (OFDI) to detect medial and intimal calcification in human peripheral arteries.

Methods: We performed ex vivo intravascular imaging of cadaveric human peripheral arteries with calcifications. IVUS and OFDI images were co-registered with histology. A total of 12 legs from nine patients were examined, and 438 cross-sectional images were co-registered with histology.

Results: OFDI could detect 183 of 231 intimal calcifications by histology, whereas IVUS could detect 194 (OFDI: sensitivity 79%, specificity 86%, area under the curve [AUC] 0.83; IVUS: sensitivity 84%, specificity 85%, AUC 0.85). Of 245 medial calcifications by histology, 160 and 164 were detected by OFDI and IVUS, respectively (OFDI: sensitivity 65%, specificity 85%, AUC 0.75; IVUS: sensitivity 67%, specificity 80%, AUC 0.74). Medial calcification with overlying intimal calcification (overlapped calcification) and an unclear border between intima and media were the main reasons for misdiagnosis. Without those 89 overlapped calcifications, sensitivity in both OFDI and IVUS was improved (OFDI: sensitivity 81%, specificity 85%, AUC 0.83; IVUS: sensitivity 88%, specificity 80%, AUC 0.84).

Conclusions: There are limitations in detecting medial calcification in overlapped intimal calcification and with an unclear border between intima and media by both IVUS and OFDI. It is important to distinguish medial calcification from intimal calcification before proceeding with endovascular therapy since different approaches will be required.

Sign in to read and download the full article

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from

calcified stenosisimaging modalitiesmiscellaneous
Peripheral interventionsIliac / Femoral / Popliteal
Read next article
EuroIntervention state of the art on robotics, imaging, and artificial intelligence in the cath lab; bleeding versus MI risk of mortality in coronary artery disease; treating refractory angina by coronary sinus narrowing; predicting cardiovascular events using coronary flow reserve and hyperaemic microvascular resistance; evaluation of obstructive coronary artery disease using coronary computed tomography angiography; long-term safety of peripheral drug-coated devices; near-infrared spectroscopy assessment of carotid lipid core plaque for stroke risk in carotid artery stenting; and more…

Latest news