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Purpose <p>This study aimed to investigate the effect and potential mechanism of plaque morphology on primary patency after endovascular therapy for femoropopliteal occlusion (FPO).</p> Materials and methods <p>A total of 355 FPO patients were divided into four groups based on the chronic total occlusion crossing approach and plaque cap morphology (CTOP) classification. The volume of the plaque cap, calcification score and hemodynamic simulation were calculated on the basis of the CT angiography images, and the effect of cap morphology on primary patency was assessed at 12&#xa0;months after therapy.</p> Results <p>Proximal concave cap lesions (CTOPs I &amp; II) were associated with fewer retrograde punctures and flow-limiting dissections (<i>p</i> &lt; 0.05). Although there was no difference in primary patency or freedom from CD-TLR among the CTOP classifications, the primary patency of proximal concave cap was significantly greater than that of convex cap (81.7 vs. 72.9%; <i>p</i> = 0.04); the freedom from CD-TLR of proximal concave cap was significantly higher than that of convex cap (91.4 vs. 81.4%; <i>p</i> = 0.006). Moreover, the proximal concave cap had a smaller plaque volume than the convex cap (26.00 ± 25.77 mm<sup>3</sup> vs. 51.26 ± 43.56 mm<sup>3</sup>, <i>p</i> &lt; 0.001), and lower severe calcification was detected in the proximal concave cap (4 vs. 28%, <i>p</i> = 0.001). Computer simulation analysis confirmed that the proximal concave cap presented a greater oscillatory shear index (0.35 + 0.20 vs. 0.07 + 0.06, <i>p</i> = 0.002).</p> Conclusions <p>The proximal concave plaque cap of the FPO indicates a smaller cap volume and lower degree of severe calcification, which helps to determine endovascular therapy strategy before procedure.</p>

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Proximal plaque cap morphology in femoropopliteal occlusion affects the primary patency of endovascular therapy: a CT angiography cohort study

  • 期刊论文

  • 发表日期：

    2026年1月20日

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  • Yanzi Li,
  • Ningning Ding,
  • Xinzhou Xie,
  • Longlong Cong,
  • Jian Dong,
  • Yang Han,
  • Lin Yang

摘要

Purpose

This study aimed to investigate the effect and potential mechanism of plaque morphology on primary patency after endovascular therapy for femoropopliteal occlusion (FPO).

Materials and methods

A total of 355 FPO patients were divided into four groups based on the chronic total occlusion crossing approach and plaque cap morphology (CTOP) classification. The volume of the plaque cap, calcification score and hemodynamic simulation were calculated on the basis of the CT angiography images, and the effect of cap morphology on primary patency was assessed at 12 months after therapy.

Results

Proximal concave cap lesions (CTOPs I & II) were associated with fewer retrograde punctures and flow-limiting dissections (p < 0.05). Although there was no difference in primary patency or freedom from CD-TLR among the CTOP classifications, the primary patency of proximal concave cap was significantly greater than that of convex cap (81.7 vs. 72.9%; p = 0.04); the freedom from CD-TLR of proximal concave cap was significantly higher than that of convex cap (91.4 vs. 81.4%; p = 0.006). Moreover, the proximal concave cap had a smaller plaque volume than the convex cap (26.00 ± 25.77 mm3 vs. 51.26 ± 43.56 mm3, p < 0.001), and lower severe calcification was detected in the proximal concave cap (4 vs. 28%, p = 0.001). Computer simulation analysis confirmed that the proximal concave cap presented a greater oscillatory shear index (0.35 + 0.20 vs. 0.07 + 0.06, p = 0.002).

Conclusions

The proximal concave plaque cap of the FPO indicates a smaller cap volume and lower degree of severe calcification, which helps to determine endovascular therapy strategy before procedure.