Magnetic resonance angiographic imaging of angioplasty and atherectomy sites

Magnetic resonance angiography (MRA) provides detailed morphologic and flow information that demonstrates complex changes at sites of percutaneous transluminal angioplasty (PTA) and atherectomy. The purpose of this study is to examine the appearance of the vessel by MRA in the initial post-procedural and early follow-up periods. Methods: MRA was performed to evaluate 35 infrainguinal endovascular procedures (20 patients), including PTA (20), atherectomy (4), and combination PTA/atherectomy (11). MRA imaging was performed within 24 hours of the procedure and at a mean follow-up interval of 3.5 months (range 1-8). Results: Abnormalities in the immediate post- procedural MRA were seen in 55% of the PTA group and 93% of the atherectomy group (p = 0.04). Importantly, three of 35 lesions (9%) were shown by MRA to harbor >50% stenoses despite angiographically 'successful' procedures. Follow-up MRA showed abnormalities in 25% of those undergoing PTA, and in 67% of those with atherectomy (p = 0.01). At the time of follow-up MRA, four areas showed >50% stenosis and four areas showed occlusion, revealing unfavorable outcomes in 22%. Conclusions: MRA provides a detailed noninvasive image of the sites of endovascular interventions and reveals vessel wall abnormalities not appreciated by conventional arteriography. Continued observation may allow prediction of segments at increased risk for restenosis.