peripheral arterial calcium scoring systems: useful tool ... · disclosure speaker name: ulrich...
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Peripheral arterial calcium scoring systems:
Useful tool or meaningless?
Ulrich Beschorner
UHZ Bad Krozingen
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Disclosure
Speaker name: Ulrich Beschorner
I have the following potential conflicts of interest to report:
Consulting/ honoraria:
C.R. Bard, J&J Cordis, Medtronic, Biotronik, W.L. Gore
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Calcification represents a significant challenge to current endovascular strategies
Calcium Limits Vessel Expansion1
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1999
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Calcium may present a challenge for DCBs Calcium is a barrier to optimal drug absorption1,2
1. Fanelli J Endovas Ther 2012;19:571-580. 2. Fanelli et al. Cardiovasc Intervent Radiol (2014) 37:898-907)
Calcium results in
HIGHER LLL
and
LOWER patency
at 12 months
SC
17
25
10
20
14
A
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Limitations of Fanellis Study:
• Single Center
• No Corelab
• No confounders analyzed
• LLL done by Ultrasound (!)
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Most important limitation in daily work:
Most of us do not routinely
perform CT-Scans or IVUS !
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Can we really quantify calcification on angiography?
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Can we really quantify calcification on angiography?
We should at least try!
Singh, Jaff, Zeller, CCI, 2014)
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Peripheral arterial calcium scoring system
PACSS
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PACSS: Limitations Lesion length / short lesions
No validation
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PACSS: Examples
PACSS 0
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PACSS: Examples
PACSS 1
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PACSS: Examples
PACSS 4
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PACSS: Examples
PACSS ?
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Alternative: Compliance 360° Score
Dattilo, Himmelstein, Cuff, Complance 360 degress trial, J Invasive Cardiol 2014
Calcification Score
Score 0 (None)
1 (Mild)
2 (Moderate)
3 (Moderately
Severe)
4 (Severe)
Circumference None <1800 (one side of vessel only)*
<1800 (one side of vessel only)
≥1800 (both sides of vessel at same
location)
≥1800 (both sides of vessel at
same location)
Length None <half total lesion length
≥half total lesion length
<half total lesion length
≥half total lesion length
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Validation: Tepe et. al. JEVT, October 2015
• Retrospective study 91 patients with femoropoliteal DCB
• 3 hospitals
• 100% angiographic 6 Mo FU
• Corelab adjudication of LLL and calcification
• Assessment of potential confounders
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Conclusion
• Calcification scoring systems are useful for clinical trials
• Not yet useful for clinical needs
• No validation yet
• First data indicate that Compliance 360° might work better than PACSS
• If assessed should be measured by a specialized corelab
• 100% angiographic 6 Mo FU
• Corelab adjudication of LLL and calcification
• Assessment of potenial confounders
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Peripheral arterial calcium scoring systems:
Useful tool or meaningless?
Ulrich Beschorner
UHZ Bad Krozingen