Dynamic Perfusion Computed Tomography for the Assessment of Concomitant Coronary Artery Disease in Patients with a History of Percutaneous Transluminal Angioplasty for Chronic Limb-Threatening Ischemia—A Pilot Study

Nagy, Ferenc T. and Olajos, Dorottya and Vattay, Borbála and Borzsák, Sarolta and Boussoussou, Melinda and Deák, Mónika and Vecsey-Nagy, Milán and Sipos, Barbara and Jermendy, Ádám L. and Tóth, Gábor G. and Nemes, Balázs and Merkely, Béla and Szili-Török, Tamás and Ruzsa, Zoltán and Szilveszter, Bálint (2023) Dynamic Perfusion Computed Tomography for the Assessment of Concomitant Coronary Artery Disease in Patients with a History of Percutaneous Transluminal Angioplasty for Chronic Limb-Threatening Ischemia—A Pilot Study. Journal of Cardiovascular Development and Disease, 10 (11). p. 443. ISSN 2308-3425

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Abstract

Background: Chronic limb-threatening ischemia (CLTI) is associated with high rates of long-term cardiovascular mortality. Exercise stress testing to detect obstructive coronary artery disease (CAD) can be difficult in this subset of patients due to inability to undergo exercise testing, presence of balanced ischemia and severe coronary artery calcification (CAC). Aim: To test the feasibility of regadenoson stress dynamic perfusion computed tomography (DPCT) in CLTI patients. Methods: Between 2018 and 2023, coronary computed tomography angiography (CTA) and, in the case of a calcium score higher than 400, DPCT, were performed in 25 CLTI patients with a history of endovascular revascularization. Results: Of the 25 patients, 19 had a calcium score higher than 400, requiring DPCT image acquisition. Obstructive CAD could be ruled out in 10 of the 25 patients. Of the 15 CTA/DPCT+patients, 13 proceeded to coronary angiography (CAG). Revascularization was necessary in all 13 patients. In these 13 patients, vessel-based sensitivity and specificity of coronary CTA/DPCTascomparedtoinvasiveevaluation was 75%, respectively. At follow-up (27 ± 21 months) there was no statistically significant difference in all-cause mortality between CTA/DPCT- positive and-negative patients (p = 0.065). Conclusions: Despite a high prevalence of severe CAC, coronary CTA complemented by DPCT may be a feasible method to detect obstructive and functionally significant CAD in CLTI patients.

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