Peripheral arterial calcium scoring systems:

Useful tool or meaningless?

Ulrich Beschorner

UHZ Bad Krozingen

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

Calcification represents a significant challenge to current endovascular strategies

Calcium Limits Vessel Expansion1

1999

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

Limitations of Fanellis Study:

• Single Center

• No Corelab

• No confounders analyzed

• LLL done by Ultrasound (!)

Most important limitation in daily work:

Most of us do not routinely

perform CT-Scans or IVUS !

Can we really quantify calcification on angiography?

Can we really quantify calcification on angiography?

We should at least try!

Singh, Jaff, Zeller, CCI, 2014)

Peripheral arterial calcium scoring system

PACSS

PACSS: Limitations Lesion length / short lesions

No validation

PACSS: Examples

PACSS 0

PACSS: Examples

PACSS 1

PACSS: Examples

PACSS 4

PACSS: Examples

PACSS ?

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

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

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

Peripheral arterial calcium scoring systems:

Useful tool or meaningless?

Ulrich Beschorner

UHZ Bad Krozingen