Our understanding of plaque morphology and its relationship with procedural complexity
and immediate technical failure (ITF) in percutaneous vascular intervention (PVI)
is poorly understood, particularly in tibial disease due to significant limitations
of CTA, DSA and DUS imaging. Ultrashort echo time (UTE) MRI is a non-contrast 3T MRI
technique that can identify and differentiate plaque morphology and characteristics.
The aim of this study was to create a UTE MRI-defined staging system to support clinicians
evaluate endovascular procedural complexity.Patients scheduled for PVI underwent pre-operative
UTE MRI. Lesions were graded based on MRI-defined anatomical characteristics and plaque
morphology on a four-scale staging system, where stage A was least severe and stage
D most severe. The primary outcome was the association of UTE Stage with ITF and was
evaluated using logistic regression. Secondary outcomes included associations between
UTE Stage and number of wire/catheter escalations required during the procedure, and
UTE Stage and number of treatment devices used. TASC scoring was also evaluated and
investigated for any influence on ITF.47 patients with 90 arterial lesions were included.
Stage D and stage C UTE MRI- defined disease strongly influenced ITF (Odds ratio 114.3,
95% CF 10.4-1257.5, p<0.001 and OR 21.0 95% CF 2.33-189.3, p=0.007 respectively).
Logistic regression identified Stage D disease was 99 times more likely to require
catheters/wire escalations for crossing (OR 0.01, p=0.004, 95% CF 0.00-0.24). UTE
MRI stage did not influence number of treatment devices used (Chi 2.53, p=0.47). Logistic
regression showed that TASC score had no influence on ITF (Chi 2.13, p=0.55).UTE-MRI
defined staging is strongly associated with ITF, crossing time and need for crossing
device escalation whereas TASC staging had no influence on ITF. This study supports
the notion that an understanding of plaque morphology and plaque characteristics is
pivotal to procedural planning.
