Ultrasound Can Predict Lumen Reentry

BY MITCHEL L. ZOLER

BALTIMORE -- B-mode, duplex ultrasound of plaque density effectively predicted successful lumen reentry during subintimal angioplasty of leg arteries in a single center retrospective analysis of 108 patients.

But this grey-scale median (GSM) technique did not predict arterial patency after subintimal angioplasty of the superficial femoral or popliteal arteries, Dr. Natalie Marks, Maimonides Medical Center, New York, said at the Vascular Annual Meeting.

She reported on data accumulated on 116 subintimal angioplasty procedures in 108 patients. The average age of patients was 73, and 62% were men. Hypertension was present in 79%, diabetes in 55%, chronic renal insufficiency in 44%, and 7% required hemodialysis. Gangrene was present in 58% of the patients, 22% had ischemic ulcers. The superficial femoral artery only was occluded in 70%, the popliteal artery only in 15%, and both were occluded in the remaining 15%.

GSM has been used to assess occlusions in carotid arteries, but not reported for use in lower-extremity vessels, Dr.Marks said.

Very echolucent plaque has a GSM of 6, and very echogenic plaque has a GSM of 48. The average GSM for all 116 occlusions was 22.5. Subintimal angioplasty failed in 17 occlusions, and their average GSM was 46. Angioplasty was successful in the other 99, and their average GSM was 18, a significant difference between the groups. Angioplasty was 100% successful when the GSM was 25 or less and never successful when the GSM was more than 40. GSM readings did not correlate with any comorbidity except the need for dialysis. The analysis also showed no significant link between GSM and the risk of thrombosis, restenosis, or reocclusion at 1 month or 6 months after angioplasty, Dr. Marks said.

Commenting on this article, Dr. R. Eugene Zierler, Vascular Laboratory, University of Washington, St. Louis, said: "This study illustrates the evolving role of vascular ultrasound in predicting intervention outcomes. As these methods are refined, it should be possible to know with a higher degree of certainty which interventions are most appropriate for specific patients."