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ABSTRACT Introduction and objectives: Coronary calcification is one of the leading factors that affect negatively the safety and effectiveness of percutaneous coronary intervention. Several calcium modification techniques exist. However, there is a lack of randomized evidence on the therapy of choice in this scenario. Methods: The ROLLERCOASTR is a prospective, multicenter, randomized clinical trial designed to compare the safety and efficacy profile of 3 plaque modification techniques in the moderate-to-severe coronary calcification setting: rotational atherectomy (RA), excimer laser coronary angioplasty (ELCA), and intravascular lithotripsy (IVL). The study primary endpoint is stent expansion evaluated by optical coherence tomography. An intention-to-treat analysis will be conducted with an alpha coefficient of 0.05 between the reference group (RA) and the remaining 2 groups (ELCA and IVL). An analysis of the study primary endpoint per protocol will be conducted for consistency purposes. If the non-inferiority hypothesis is confirmed, a superiority 2-sided analysis will be conducted. Both the clinical events committee and the independent core laboratory will be blinded to the treatment arm. Assuming an α error of 0.05, an β error of 0.2 (80% power), a margin of irrelevance (ε) of 7, and losses of 10% due to measurement difficulty or impossibility to complete the intervention, we estimate a sample size of 56 cases per group. The study secondary endpoints are device success, procedural success, crossover rate among the different techniques used, and the occurrence of major adverse cardiovascular events at 1-year follow-up. Conclusions: The ROLLERCOASTR trial will evaluate and compare the safety and effectiveness of 3 plaque modification techniques: RA, ELCA, and IVL in patients with calcified coronary stenosis. This trial was registered at clinicaltrials.gov with identifier NCT04181268.

Background: The Agatston score on noncontrast computed tomography (CT) scans is the gold standard for calcium load determination. However, contrast-enhanced CT is commonly used for patients with atherosclerotic cardiovascular diseases (ASCVDs), such as peripheral arterial occlusive disease (PAOD) and abdominal aortic aneurysm (AAA). Currently, there is no validated method to determine calcium load in the aorta and peripheral arteries with a contrast-enhanced CT. This study validated a length-adjusted calcium score (LACS) method for contrast-enhanced CT scans. Method: The LACS (calcium volume in mm3/arterial length in cm) in the abdominal aorta was calculated using four-phase liver CT scans of 30 patients treated between 2017 and 2021 at the University Medical Center Groningen (UMCG) with no aortic disease. Noncontrast CT scans were segmented with a 130 Hounsfield units (HU) threshold, and a patient-specific threshold was used for contrast-enhanced CTs. The LACS was calculated and compared from both segmentations. Secondly, the interobserver variability and the influence of slice thickness (0.75 mm vs. 2.0 mm) was determined. Results: There was a high correlation between the LACS from contrast-enhanced CT scans and the LACS of noncontrast CTs (R2 = 0.98). A correction factor of 1.9 was established to convert the LACS derived from contrast-enhanced CT to noncontrast CT scans. LACS interobserver agreement on contrast-enhanced CT was excellent (1.0, 95% confidence interval = 1.0–1.0). The 0.75 mm CT threshold was 541 (459–625) HU compared with 500 (419–568) HU on 2 mm CTs (p = 0.15). LACS calculated with both thresholds was not significantly different (p = 0.63). Conclusion: The LACS seems to be a robust method for scoring calcium load on contrast-enhanced CT scans in arterial segments with various lengths. [ABSTRACT FROM AUTHOR]

Peripheral artery disease is a condition that occurs due to narrowing or occlusion of arterial lumen usually secondary to atherosclerosis. Endovascular treatments are minimally invasive procedures that have become popular for recanalization of such calcified/sclerosed arteries. However, heavily calcified arteries make these procedures challenging and are more prone to complications like balloon rupture and bleeding. Herein, we report a novel case of rupture of superficial femoral artery and its management using self-expanding Supera stent.

Background: Carotid atherosclerosis is one of the main cerebrovascular complications in kidney transplant recipients (KTRs). We analyzed the relationships between carotid intima-media thickness (IMT) and the occurrence and characteristics of carotid plaques in a cohort of KTRs. Methods: In 500 KTRs (aged 49.9 ± 12.0 years), IMT was measured and carotid plaques were semi-qualitatively assessed. Concomitantly, biochemical and hormonal inflammatory, vascular and calcium-phosphate metabolism parameters were also assessed. Results: In 10.2%of patients, a side-to-side IMT difference>0.1mmwas observed, whereas 26.8%of patients with no plaques in one carotid artery had at least one contralateral calcified plaque. Multivariate logistic regression analysis revealed that age (rpartial = 0.409; p < 0.001), male sex (rpartial = 0.199; p < 0.001), and coronary artery disease (rpartial = 0.139; p < 0.01) independently increased IMT (R² = 0.25). For the occurrence of calcified carotid plaques, age (rpartial = 0.544; p < 0.001), male gender (rpartial = 0.127; p < 0.05), and the duration of renal insufficiency prior to transplantation (rpartial = 0.235; p < 0.001) were confirmed as independent variables. Conclusions: Substantial side-to-side differences in IMT values and carotid plaques distribution are present in a large percentage of stable KTRs. In addition, there are different clinical risk factors profiles associated with IMT and the presence of calcified plaques. Vascular and calcium-phosphate metabolism biomarkers were not associated with any carotid atherosclerosis characteristics. [ABSTRACT FROM AUTHOR]

Peripheral artery disease is a condition that occurs due to narrowing or occlusion of arterial lumen usually secondary to atherosclerosis. Endovascular treatments are minimally invasive procedures that have become popular for recanalization of such calcified/sclerosed arteries. However, heavily calcified arteries make these procedures challenging and are more prone to complications like balloon rupture and bleeding. Herein, we report a novel case of rupture of superficial femoral artery and its management using self-expanding Supera stent. [ABSTRACT FROM AUTHOR]

Background: The Agatston score on noncontrast computed tomography (CT) scans is the gold standard for calcium load determination. However, contrast-enhanced CT is commonly used for patients with atherosclerotic cardiovascular diseases (ASCVDs), such as peripheral arterial occlusive disease (PAOD) and abdominal aortic aneurysm (AAA). Currently, there is no validated method to determine calcium load in the aorta and peripheral arteries with a contrast-enhanced CT. This study validated a length-adjusted calcium score (LACS) method for contrast-enhanced CT scans. Method: The LACS (calcium volume in mm3/arterial length in cm) in the abdominal aorta was calculated using four-phase liver CT scans of 30 patients treated between 2017 and 2021 at the University Medical Center Groningen (UMCG) with no aortic disease. Noncontrast CT scans were segmented with a 130 Hounsfield units (HU) threshold, and a patient-specific threshold was used for contrast-enhanced CTs. The LACS was calculated and compared from both segmentations. Secondly, the interobserver variability and the influence of slice thickness (0.75 mm vs. 2.0 mm) was determined. Results: There was a high correlation between the LACS from contrast-enhanced CT scans and the LACS of noncontrast CTs (R2 = 0.98). A correction factor of 1.9 was established to convert the LACS derived from contrast-enhanced CT to noncontrast CT scans. LACS interobserver agreement on contrast-enhanced CT was excellent (1.0, 95% confidence interval = 1.0–1.0). The 0.75 mm CT threshold was 541 (459–625) HU compared with 500 (419–568) HU on 2 mm CTs (p = 0.15). LACS calculated with both thresholds was not significantly different (p = 0.63). Conclusion: The LACS seems to be a robust method for scoring calcium load on contrast-enhanced CT scans in arterial segments with various lengths.

Purpose: An investigation of coronary computed tomography angiography (CCTA)-derived quantitative parameters to determine CAD-RADS 4 versus CAD-RADS 3 of coronary lesions with moderate to severe calcification. Material and methods: The study included 150 coronary lesions proven to have moderate or severe stenosis by invasive coronary angiography and showing moderate to severe calcification in CCTA. Various CCTA-quantitative parameters were correlated to the degree of stenosis (moderately versus severely stenosed lesions). Their sensitivity and specificity to detect severe stenosis (supposed to be corresponding to CAD-RADS 4) were examined at multiple cut-off points. Results: The calcification remodelling index (CRI) was the only statistically significant independent computed tomography angiography-derived predictor of severe stenosis versus moderate stenosis on multivariate regression analysis. The best cut-off value was ≤ 0.84, with 77.78% sensitivity and 86.46% specificity. Conclusions: From all quantitative-derived CCTA parameters, CRI ≤ 0.84 was the predictor with the highest diagnostic performance for severe versus moderate stenosis in moderately to severely calcified coronary lesions. Accordingly, CRI can help to determine CAD-RADS 4 versus CAD-RADS 3. [ABSTRACT FROM AUTHOR]

Background: Carotid atherosclerosis is one of the main cerebrovascular complications in kidney transplant recipients (KTRs). We analyzed the relationships between carotid intima-media thickness (IMT) and the occurrence and characteristics of carotid plaques in a cohort of KTRs. Methods: In 500 KTRs (aged 49.9 ± 12.0 years), IMT was measured and carotid plaques were semi-qualitatively assessed. Concomitantly, biochemical and hormonal inflammatory, vascular and calcium-phosphate metabolism parameters were also assessed. Results: In 10.2% of patients, a side-to-side IMT difference >0.1 mm was observed, whereas 26.8% of patients with no plaques in one carotid artery had at least one contralateral calcified plaque. Multivariate logistic regression analysis revealed that age (rpartial = 0.409; p < 0.001), male sex (rpartial = 0.199; p < 0.001), and coronary artery disease (rpartial = 0.139; p < 0.01) independently increased IMT (R2 = 0.25). For the occurrence of calcified carotid plaques, age (rpartial = 0.544; p < 0.001), male gender (rpartial = 0.127; p < 0.05), and the duration of renal insufficiency prior to transplantation (rpartial = 0.235; p < 0.001) were confirmed as independent variables. Conclusions: Substantial side-to-side differences in IMT values and carotid plaques distribution are present in a large percentage of stable KTRs. In addition, there are different clinical risk factors profiles associated with IMT and the presence of calcified plaques. Vascular and calcium-phosphate metabolism biomarkers were not associated with any carotid atherosclerosis characteristics.

Carotid artery calcification is frequently noted in panoramic dental radiographs but more evident on cone beam computed tomography (CBCT) examinations. Vertebral artery calcification and ectasia, although rare, can place the patient for equal risk for a cerebrovascular accident (stroke). The aim of this article is to radiographically identify calcified atheromatous plaque, as well as, atresia related to vertebral artery in large field of view CBCT examinations. This article presents two patients with radiographic diagnosis of vertebral artery disease. In case 1, the large field of view CBCT volume was obtained for evaluation of the temporomandibular joints. A curvilinear high-density structure was seen within the left transverse foramen of C3. Based on the density, location, and shape, a radiographic diagnosis of calcified atheromatous plaque was made. The patient was referred to her physician for management. In case 2, irregularly shaped, small, high-density structures were noted on the CBCT examination close to the left carotid bifurcation at the level of C3–C4. It was also noted that the left transverse foramen of C4 was enlarged. A diagnosis of calcified atheroma of left carotid was made in patient 1, and calcified atheromatous plaque in the left carotid bifurcation area and concomitant vertebral artery ectasia was made in patient 2. Both the patients were referred to their physicians for management. Although prevalence of carotid artery stenosis and calcification is noted more frequently in CBCT examinations, vertebral artery calcification or ectasia is rare but because of its potential risk for causation of stroke, identification is paramount.

Carotid artery stenting (CAS) has become an alternative strategy to carotid endarterectomy for carotid artery stenosis. Residual stenosis was an independent risk factor for restenosis, with the latter affecting the long-term outcomes of CAS. This multicenter study aimed to evaluate the echogenicity of plaques and hemodynamic alteration by color duplex ultrasound (CDU) examination and investigate their effects on the residual stenosis after CAS. From June 2018 to June 2020, 454 patients (386 males and 68 females) with a mean age of 67.2 ± 7.9 years, who underwent CAS from 11 advanced stroke centers in China were enrolled. One week before recanalization, CDU was used to evaluate the responsible plaques, including the morphology (regular or irregular), echogenicity of the plaques (iso-, hypo-, or hyperechoic) and calcification characteristics (without calcification, superficial calcification, inner calcification, and basal calcification). One week after CAS, the alteration of diameter and hemodynamic parameters were evaluated by CDU, and the occurrence and degree of residual stenosis were determined. In addition, magnetic resonance imaging was performed before and during the 30-day postprocedural period to identify new ischemic cerebral lesions. The rate of composite complications, including cerebral hemorrhage, symptomatic new ischemic cerebral lesions, and death after CAS, was 1.54% (7/454 cases). The rate of residual stenosis after CAS was 16.3% (74/454 cases). After CAS, both the diameter and peak systolic velocity (PSV) improved in the preprocedural 50% to 69% and 70% to 99% stenosis groups (P <.05). Compared with the groups without residual stenosis and with <50% residual stenosis, the PSV of all three segments of stent in the 50% to 69% residual stenosis group were the highest, and the difference in the midsegment of stent PSV was the largest (P <.05). Logistic regression analysis showed that preprocedural severe (70% to 99%) stenosis (odds ratio [OR], 9.421; P =.032), hyperechoic plaques (OR, 3.060; P =.006) and plaques with basal calcification (OR, 1.885; P =.049) were independent risk factors for residual stenosis after CAS. Patients with hyperechoic and calcified plaques of the carotid stenosis are at a high risk of residual stenosis after CAS. CDU is an optimal, simple and noninvasive imaging method to evaluate plaque echogenicity and hemodynamic alterations during the perioperative period of CAS, which can help surgeons to select the optimal strategies and prevent the occurrence of residual stenosis. [ABSTRACT FROM AUTHOR]