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Patients With Rutherford 3 Chronic Limb Ischemia Have A High Risk Of Severe Silent Coronary Artery Disease Found On Cta Coronary And Computed Tomography-derived Flow Reserve
Conall Monahan, BS, Halim Yammine, MD, Fanny Alie-Cusson, MD, Gregory Stanley, MD, Charles Briggs, MD, Natalie Ray, Zoe Brokaw, Camden West, Kellie Safrit, RN, Frank R. Arko, III, MD.
Sanger Heart and Vascular Institute, Atrium Health, charlotte, NC, USA.
Objective: To evaluate the incidence of severe coronary artery disease (CAD) utilizing coronary computed tomography angiography (cCTA) and computed tomography-derived fractional flow reserve (FFR
CT) in patients with Rutherford 3 chronic limb ischemia.
Methods: From August 2023 to August 2024, patients with no prior history of CAD who were evaluated by our service for Rutherford 3 claudication were ordered a cCTA and FFR
CT. Moderate CAD was defined as FFR
CT ≤ 0.80 and/or coronary stenosis as 50-69%, while severe CAD as FFR
CT ≤0.75 and/or stenosis ≥70%. Patients who did not get the cCTA were excluded.
Results: 37 patients met the inclusion criteria. The average age was 68.8. 11 patients had minimal CAD on cCTA (no FFR
CT was obtained) and FFR
CT showed minimal disease in 7 patients for a total of 18/37 (48.6%). 19/37 (51.4%) patients were found to have at minimum moderate CAD and 12/37 (32.4%) had severe CAD in at least one vessel. 4/37 (10.8%) patients had multi-vessel severe CAD. A total of 6 patients (16.2%) underwent heart catheterizations (3/6 had PCI) and 1 patient underwent a coronary artery bypass graft (CABG) for a total of 4/37 (10.8%) coronary intervention due to cCTA and FFR
CT results. The other 2 patients did not undergo any further interventions (table 1). A total of 3/37 (8.1%) patients had severe proximal to mid disease in a dominant vessel. Of note, one patient suffered from a myocardial infraction (MI) and had a heart catheterization before their cCTA and FFR
CT could be obtained.
Conclusions: Patients with Rutherford 3 claudication and no known history of CAD are at an increased risk of having severe silent CAD as 11% of these patients required a coronary intervention. This suggests that screening Rutherford 3 patients with cCTA and FFR
CT can reduce the risk of major adverse cardiac events (MACE) and potentially mortality in this patient population.
Table 1. Patients who underwent coronary angiography after the cCTA, and FFR
CT results
| | | |
| Patient Number | Type of Coronary Angiography(elective or urgent) | Vessels Stenosis | Secondary Cardiac Treatment and reasoning |
| 1 | elective | Proximal Left Circumflex (LCX) 50%, Proximal Left Anterior Descending (LAD) 20%, Right Coronary Artery (RCA) 20% | NO PCI |
| 2 | elective | 1st Obtuse Marginal (OM)80%, Mid LAD 75%, 1st Diagonal 40% | 1st OM and Mid LAD Stents |
| 3 | elective | Proximal to Mid RCA 100% | No PCI |
| 4 | elective | Proximal to Mid LAD 50%, Proximal to Mid LCX 90%, Proximal and Distal RCA 50% | Proximal to Mid LCX Stent |
| 5 | elective | Proximal to Mid RCA 50% Distal RCA 95%, Mid to Distal Left Main (LM) 75%, Mid LAD 75%, Right Posterior Descending Artery (RPDA) 75%, Ramus 75%, 1st Diagonal 75% | Elective CABG 6x (LIMA, Aorto to RPDA/RPL1 OM1, diagonal 1, diagonal 2, LIMA to LAD) |
| 6 | elective | Distal LM 30%, Ostial LCX 60%, 1st OM 90% | 1st OM Stent |
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