{"id":{"repo_id":"cambridge","oai_identifier":"oai:www.repository.cam.ac.uk:1810/306869"},"canonical_url":"https://search.dev.ndltd.org/etd/cambridge/oai:www.repository.cam.ac.uk:1810/306869","repository":{"repo_id":"cambridge","name":"Cambridge University","base_url":"https://api.repository.cam.ac.uk/server/oai/request"},"display":{"title":"Multi-modality Imaging to Determine the Role of Calcification and Inflammation on Restenosis Rates Following Lower Limb Angioplasty","abstract":"Peripheral arterial disease (PAD) is a major cause of CVD-related death and disability. Restenosis is common, occurring in 40-60% of cases at 12 months following lower extremity percutaneous transluminal angioplasty (PTA). No such method exists to identify patients who are at risk from restenosis before intervention. Tracers of inflammation (18F-FDG; fluorodeoxyglucose) and calcification (18F-NaF; sodium fluoride) are higher in restenosis following lower limb angioplasty in patients with peripheral arterial disease, and drug-coated balloons (DCB) dampen the inflammatory process, in an atherosclerotic rabbit model. In the prospective clinical study arm (CA), 50 patients with symptomatic PAD underwent 18F-NaF and 18F-FDG PET imaging of the superficial femoral artery (SFA), pre- and 6-weeks post-angioplasty. The primary outcome was restenosis at 12 months. DCB PTA was studied (compared to plain PTA) using near infrared fluorescence-optical coherence tomography hybrid imaging (NIRF-OCT) and plaque burden assessed by intravascular ultrasound (IVUS), in the experimental arm (EA). 40 patients were used for formal analysis. 14 patients (35%) reached the primary outcome of restenosis. Pre-PTA TBRmax in the restenosis group for 18F-FDG (2.43 [IQR 2.29 – 2.61] and 18F-NaF (2.61 [IQR 2.50 – 2.77]) were higher than the no-restenosis equivalent groups (1.63 [IQR 1.52 – 1.78] and 1.69 [IQR 1.54 – 1.77], p< 0.001). Furthermore, in the no-restenosis group there was a drop in both 18F-FDG and 18F-NaF tracer uptake (p=0.034 and 0.047, respectively) between the two timepoints; a finding not observed in the restenosis group. Experimentally, Plaque pathobiology assessment using NIRF after PTA vs. DCB treatment (42.91 nM vs 17.35 nM, p = 0.028) favoured DCB use to reduce inflammatory effects of angioplasty. Furthermore, DCB use demonstrated neointimal area regression (-2.55 % [IQR -5.35 to -0.43]) versus growth with PTA use (+6.29% [IQR 4.20 – 7.79]; p =0.002), as assessed by IVUS. Together our findings suggest that non-invasive and invasive structural-molecular imaging provide unique but complementary insights into the pathophysiology of restenosis, specifically inflammatory and calcific mediators of arterial remodelling following injury.","abstract_html":"Peripheral arterial disease (PAD) is a major cause of CVD-related death and disability. Restenosis is common, occurring in 40-60% of cases at 12 months following lower extremity percutaneous transluminal angioplasty (PTA). No such method exists to identify patients who are at risk from restenosis before intervention. Tracers of inflammation (18F-FDG; fluorodeoxyglucose) and calcification (18F-NaF; sodium fluoride) are higher in restenosis following lower limb angioplasty in patients with peripheral arterial disease, and drug-coated balloons (DCB) dampen the inflammatory process, in an atherosclerotic rabbit model. In the prospective clinical study arm (CA), 50 patients with symptomatic PAD underwent 18F-NaF and 18F-FDG PET imaging of the superficial femoral artery (SFA), pre- and 6-weeks post-angioplasty. The primary outcome was restenosis at 12 months. DCB PTA was studied (compared to plain PTA) using near infrared fluorescence-optical coherence tomography hybrid imaging (NIRF-OCT) and plaque burden assessed by intravascular ultrasound (IVUS), in the experimental arm (EA). 40 patients were used for formal analysis. 14 patients (35%) reached the primary outcome of restenosis. Pre-PTA TBRmax in the restenosis group for 18F-FDG (2.43 [IQR 2.29 – 2.61] and 18F-NaF (2.61 [IQR 2.50 – 2.77]) were higher than the no-restenosis equivalent groups (1.63 [IQR 1.52 – 1.78] and 1.69 [IQR 1.54 – 1.77], p&lt; 0.001). Furthermore, in the no-restenosis group there was a drop in both 18F-FDG and 18F-NaF tracer uptake (p=0.034 and 0.047, respectively) between the two timepoints; a finding not observed in the restenosis group. Experimentally, Plaque pathobiology assessment using NIRF after PTA vs. DCB treatment (42.91 nM vs 17.35 nM, p = 0.028) favoured DCB use to reduce inflammatory effects of angioplasty. Furthermore, DCB use demonstrated neointimal area regression (-2.55 % [IQR -5.35 to -0.43]) versus growth with PTA use (+6.29% [IQR 4.20 – 7.79]; p =0.002), as assessed by IVUS. Together our findings suggest that non-invasive and invasive structural-molecular imaging provide unique but complementary insights into the pathophysiology of restenosis, specifically inflammatory and calcific mediators of arterial remodelling following injury.","abstract_has_math":false,"creators":["Chowdhury, Mohammed"],"institution":"University of Cambridge","degree_name":"Doctor of Philosophy (PhD)","degree_level":"Doctoral","degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":["Hayes, Paul","Rudd, James HF","Coughlin, Patrick"],"committee_chairs":[],"committee_members":[],"year":2020,"date_issued":"2020-06-08","date_published":"2020-06-08","updated_at":"2026-07-22T22:24:23Z","subjects":["PAD","Molecular imaging","PET/CT","Restenosis"],"languages":["eng"],"rights":[],"rights_urls":["https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/3e2913f6-1360-4dfe-948b-a47630dbfde4/download","http://purl.org/NET/rdflicense/allrightsreserved"],"identifier_entries":[]},"links":{"outbound_url":"https://doi.org/10.17863/CAM.53961","outbound_label":"DOI","outbound_source":"dc:identifier.doi"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Hayes, Paul","Rudd, James HF","Coughlin, Patrick"]},{"key":"dc:creator","label":"Author","values":["Chowdhury, Mohammed"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.issued","label":"Date","values":["2020-06-08"]},{"key":"dc:publisher.institution","label":"Dc Publisher Institution","values":["University of Cambridge"]},{"key":"dc:relation.isreferencedby.uri","label":"Dc Relation Isreferencedby URI","values":["https://www.repository.cam.ac.uk/handle/1810/306869"]},{"key":"dc:type","label":"Dc Type","values":["Thesis"]},{"key":"dc:type.qualificationlevel","label":"Dc Type Qualificationlevel","values":["Doctoral"]},{"key":"dc:type.qualificationname","label":"Dc Type Qualificationname","values":["Doctor of Philosophy (PhD)"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["PAD","Molecular imaging","PET/CT","Restenosis"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["eng"]},{"key":"dc:rights","label":"Dc Rights","values":["https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/3e2913f6-1360-4dfe-948b-a47630dbfde4/download","http://purl.org/NET/rdflicense/allrightsreserved"]},{"key":"dc:rights.embargotype","label":"Dc Rights Embargotype","values":["controlled.access"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.doi","label":"DOI","values":["10.17863/CAM.53961"]},{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/9b21843b-a9d7-4671-9279-522816bc5384/download"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Peripheral arterial disease (PAD) is a major cause of CVD-related death and disability. Restenosis is common, occurring in 40-60% of cases at 12 months following lower extremity percutaneous transluminal angioplasty (PTA). No such method exists to identify patients who are at risk from restenosis before intervention. Tracers of inflammation (18F-FDG; fluorodeoxyglucose) and calcification (18F-NaF; sodium fluoride) are higher in restenosis following lower limb angioplasty in patients with peripheral arterial disease, and drug-coated balloons (DCB) dampen the inflammatory process, in an atherosclerotic rabbit model. In the prospective clinical study arm (CA), 50 patients with symptomatic PAD underwent 18F-NaF and 18F-FDG PET imaging of the superficial femoral artery (SFA), pre- and 6-weeks post-angioplasty. The primary outcome was restenosis at 12 months. DCB PTA was studied (compared to plain PTA) using near infrared fluorescence-optical coherence tomography hybrid imaging (NIRF-OCT) and plaque burden assessed by intravascular ultrasound (IVUS), in the experimental arm (EA). 40 patients were used for formal analysis. 14 patients (35%) reached the primary outcome of restenosis. Pre-PTA TBRmax in the restenosis group for 18F-FDG (2.43 [IQR 2.29 – 2.61] and 18F-NaF (2.61 [IQR 2.50 – 2.77]) were higher than the no-restenosis equivalent groups (1.63 [IQR 1.52 – 1.78] and 1.69 [IQR 1.54 – 1.77], p< 0.001). Furthermore, in the no-restenosis group there was a drop in both 18F-FDG and 18F-NaF tracer uptake (p=0.034 and 0.047, respectively) between the two timepoints; a finding not observed in the restenosis group. Experimentally, Plaque pathobiology assessment using NIRF after PTA vs. DCB treatment (42.91 nM vs 17.35 nM, p = 0.028) favoured DCB use to reduce inflammatory effects of angioplasty. Furthermore, DCB use demonstrated neointimal area regression (-2.55 % [IQR -5.35 to -0.43]) versus growth with PTA use (+6.29% [IQR 4.20 – 7.79]; p =0.002), as assessed by IVUS. 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Restenosis is common, occurring in 40-60% of cases at 12 months following lower extremity percutaneous transluminal angioplasty (PTA). No such method exists to identify patients who are at risk from restenosis before intervention. Tracers of inflammation (18F-FDG; fluorodeoxyglucose) and calcification (18F-NaF; sodium fluoride) are higher in restenosis following lower limb angioplasty in patients with peripheral arterial disease, and drug-coated balloons (DCB) dampen the inflammatory process, in an atherosclerotic rabbit model. In the prospective clinical study arm (CA), 50 patients with symptomatic PAD underwent 18F-NaF and 18F-FDG PET imaging of the superficial femoral artery (SFA), pre- and 6-weeks post-angioplasty. The primary outcome was restenosis at 12 months. DCB PTA was studied (compared to plain PTA) using near infrared fluorescence-optical coherence tomography hybrid imaging (NIRF-OCT) and plaque burden assessed by intravascular ultrasound (IVUS), in the experimental arm (EA). 40 patients were used for formal analysis. 14 patients (35%) reached the primary outcome of restenosis. Pre-PTA TBRmax in the restenosis group for 18F-FDG (2.43 [IQR 2.29 – 2.61] and 18F-NaF (2.61 [IQR 2.50 – 2.77]) were higher than the no-restenosis equivalent groups (1.63 [IQR 1.52 – 1.78] and 1.69 [IQR 1.54 – 1.77], p< 0.001). Furthermore, in the no-restenosis group there was a drop in both 18F-FDG and 18F-NaF tracer uptake (p=0.034 and 0.047, respectively) between the two timepoints; a finding not observed in the restenosis group. Experimentally, Plaque pathobiology assessment using NIRF after PTA vs. DCB treatment (42.91 nM vs 17.35 nM, p = 0.028) favoured DCB use to reduce inflammatory effects of angioplasty. Furthermore, DCB use demonstrated neointimal area regression (-2.55 % [IQR -5.35 to -0.43]) versus growth with PTA use (+6.29% [IQR 4.20 – 7.79]; p =0.002), as assessed by IVUS. Together our findings suggest that non-invasive and invasive structural-molecular imaging provide unique but complementary insights into the pathophysiology of restenosis, specifically inflammatory and calcific mediators of arterial remodelling following injury."],"dc:format.checksum.md5":["fc56a29f29896e591402eda5699b237e","353adac0d1ebdfd65ab16480263c3c87"],"dc:identifier.doi":["10.17863/CAM.53961"],"dc:identifier.uri":["https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/9b21843b-a9d7-4671-9279-522816bc5384/download"],"dc:language":["eng"],"dc:publisher.institution":["University of Cambridge"],"dc:relation.isreferencedby.uri":["https://www.repository.cam.ac.uk/handle/1810/306869"],"dc:rights":["https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/3e2913f6-1360-4dfe-948b-a47630dbfde4/download","http://purl.org/NET/rdflicense/allrightsreserved"],"dc:rights.embargotype":["controlled.access"],"dc:subject":["PAD","Molecular imaging","PET/CT","Restenosis"],"dc:title":["Multi-modality Imaging to Determine the Role of Calcification and Inflammation on Restenosis Rates Following Lower Limb Angioplasty"],"dc:type":["Thesis"],"dc:type.qualificationlevel":["Doctoral"],"dc:type.qualificationname":["Doctor of Philosophy (PhD)"]},"updated_at":"2026-07-22T22:24:23Z"}