Prevalence and Significance of Calcium, Vulnerable Plaque and Plaque Morphology in Peripheral Artery Disease (PAD)

The presence of calcium in lower limb arteries is known to impact outcomes of endovascular procedures including balloon angioplasty, stenting and drug eluting balloons. Calcium is also associated with amputation and higher mortality in peripheral artery disease.

However, the actual prevalence of vascular calcification in symptomatic peripheral artery disease patients is unknown. In addition, plaque morphology and components have not been well studied in the leg arteries. While a large body of literature has been published on the presence and significance of vulnerable plaque in the coronary arteries, this topic is significantly under-researched in the leg arteries.

This report contains a comprehensive analysis of the peer-reviewed literature published on plaque morphology, vulnerable plaque and calcium in PAD patients. Chronic total occlusion prevalence and composition, as well as thrombus is also reviewed. The analysis includes definitions of calcium and plaque as well as a discussion of the imaging modalities employed to detect and measure calcium, other lesion components and plaque morphology.

The primary purpose of this research is to estimate prevalence and impact on patients and lesion characteristics of: calcium, vulnerable plaque and chronic total occlusions. Based on the available data percentage prevalence is estimated by vascular territory (above-the-knee or below-the knee) and by disease severity (intermittent claudication and critical limb ischemia).

A discussion of the importance of lesion eccentricity and its impact on plaque vulnerability is featured. The relationship of calcium to eccentric lesions, the impact of eccentricity on plaque vulnerability, eccentric plaque prevalence by vascular territory and impact of eccentricity on disease severity is reviewed.

The number of symptomatic U.S. patients and limbs with calcified lesions in 2015-2030 is estimated. Symptomatic patients are defined as those with intermittent claudication (IC) and critical limb ischemia (CLI). These estimates are based on THE SAGE GROUP’s recently revised PAD and CLI estimates in combination with the conclusions regarding the percentage of patients with calcified leg arteries.

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