To Cross or Not to Cross: Using MRI-Histology to Characterize Dense Collagenous Plaque in Critical Limb Ischemia

Kajol J. Shah, Bright Benfor, Christof Karmonik, Alan B. Lumsden, Trisha L. Roy

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Peripheral artery disease (PAD) is caused by atherosclerotic buildup in the lower extremities, leading to obstruction and inadequate perfusion to the peripheral vasculature. Impenetrable plaques initially treated with percutaneous vascular intervention (PVI) have led to worse secondary bypass outcomes and amputation in patients. In this case report, we discuss the importance of using magnetic resonance imaging (MRI) histology in PVI planning in a patient with critical limb ischemia. PVI attempts to recanalize the limb failed because of an impenetrable occlusion in the popliteal artery that was not identified on routine preoperative imaging. Subsequent bypass occluded multiple times eventually requiring an above-knee amputation. An MRI-histology protocol-using ultrashort echo time (UTE) and T2-weighted (T2W) sequences-that was performed prior to the index PVI identified the occlusion as a dense collagen plaque. Histology analysis of the amputated specimen confirmed the MRI finding. This imaging modality offers a novel approach to characterize plaque composition and morphology, thereby identifying lesions at greatest risk of PVI failure and potentially playing an important role in selecting the right candidates for an endovascular-first approach.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalMethodist DeBakey cardiovascular journal
Issue number1
StatePublished - 2023


  • MRA
  • MRI
  • PAD
  • angioplasty
  • atherosclerosis
  • endovascular treatment/therapy
  • magnetic resonance angiography
  • magnetic resonance imaging
  • peripheral artery disease
  • plaque morphology
  • ultrashort echo time sequence
  • vascular imaging
  • Humans
  • Risk Factors
  • Ischemia/diagnostic imaging
  • Peripheral Arterial Disease/diagnostic imaging
  • Treatment Outcome
  • Chronic Limb-Threatening Ischemia
  • Magnetic Resonance Imaging
  • Retrospective Studies
  • Plaque, Atherosclerotic/complications
  • Limb Salvage/adverse effects

ASJC Scopus subject areas

  • Medicine(all)


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