Vascular Positron Emission Tomography and Restenosis in Symptomatic Peripheral Arterial Disease

Atherosclerosis Imaging with 18F-Sodium Fluoride PET

“…We found 35 eligible articles. Three on the aortic valve ( n = 3) and seven on methodology ( n = 7) were excluded based on the abovementioned criteria, leaving 25 dealing with the coronary arteries [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ], femoral artery [ 12 , 13 , 14 , 15 ], abdominal aorta [ 16 , 17 , 18 ], carotid arteries [ 19 , 20 ], thoracic aorta [ 21 ], and intracranial [ 22 ], renal [ 23 ], and penile arteries [ 24 ]. One study focused on the carotid and cerebral arteries [ 25 ], another on the carotids, the aortic arch, and coronary arteries [ 26 ], and a third on several major arteries [ 27 ].…”

“…One study focused on the carotid and cerebral arteries [ 25 ], another on the carotids, the aortic arch, and coronary arteries [ 26 ], and a third on several major arteries [ 27 ]. Below (and in Supplementary Materials Tables S1–S5 ), the literature is summarized in six sections before being debated in the discussion: Disease mechanisms and targeting [ 10 ], Early detection and prevalence of NaF uptake in the heart and major arteries [ 5 , 23 , 24 , 25 , 27 ], NaF uptake in vulnerable, high risk, and ruptured plaque [ 6 , 7 , 8 , 9 , 19 , 20 ], Influence of age, sex, and other factors on NaF uptake [ 3 , 16 , 22 ], Association between NaF uptake and cardiovascular risk factors [ 4 , 15 , 21 ], NaF uptake and disease progression [ 11 , 12 , 13 , 14 , 17 , 18 , 26 ]. …”

“…FDG coronary artery uptake above TBR 1.98 and NaF TBR above 2.11 were both highly discriminative with regard to restenosis after one year, whereas the index lesion CT calcium score was not. There was a significant positive correlation between symptomatic lesion uptake of NaF and calcium score, but not between FDG uptake and calcium score [ 12 ]. Zwackenberg et al studied femoral artery NaF uptake in 35 women and men with DM2 and cardiovascular disease, who in a randomized trial received 360 µg/d menaquinone-7 (MK-7) or placebo.…”

“…Chowdhury et al demonstrated that baseline uptake of both FDG and NaF could predict one-year femoral restenosis following percutaneous transluminal coronary angioplasty, whereas there was no difference in index lesion calcium score by CT between those who did or did not develop restenosis. There was a positive correlation between symptomatic lesion uptake of NaF, but not FDG, and calcium score [ 12 ]. Treatment of DM2 and cardiovascular disease with mena-quinone-7 (MK-7) was associated with an insignificant trend for increased NaF uptake in the femoral artery, whereas the same was not apparent for CT-calcification [ 13 ].…”

Absence of Long-Term Benefit of Revascularization in Patients With Intermittent Claudication

“…Invasive treatment is constantly developing, and new endovascular technology might provide better long-term patency for IC procedures. More precise targeting of patients might be possible in the future, with more advanced imaging to select which patients are likely to develop restenosis after invasive procedures 94 .…”