Contralateral-controlled thigh muscle biomarkers on CT angiography for prediction of 1-year restenosis after endovascular therapy for unilateral peripheral artery disease

@article{lin2026contralateralcontrolled,
  title = {{Contralateral-controlled thigh muscle biomarkers on CT angiography for prediction of 1-year restenosis after endovascular therapy for unilateral peripheral artery disease}},
  author = {Shuangxiang Lin and Xinhong Wang and Yifeng Pan and Libing Zhang and Jianzhong Sun and Bing Chen},
  journal = {Insights into Imaging},
  year = {2026},
  month = oct,
  doi = {10.1186/s13244-026-02407-0},
  url = {https://link.springer.com/10.1186/s13244-026-02407-0},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Contralateral-controlled thigh muscle biomarkers on CT angiography for prediction of 1-year restenosis after endovascular therapy for unilateral peripheral artery disease
AU  - Shuangxiang Lin
AU  - Xinhong Wang
AU  - Yifeng Pan
AU  - Libing Zhang
AU  - Jianzhong Sun
AU  - Bing Chen
PY  - 2026
DA  - 2026/10/07
JO  - Insights into Imaging
DO  - 10.1186/s13244-026-02407-0
UR  - https://link.springer.com/10.1186/s13244-026-02407-0
AB  - Objective: To develop and internally validate a model using contralateral-controlled thigh muscle biomarkers, measured on routine computed tomography angiography (CTA), to predict clinically driven, DSA-confirmed 1-year restenosis after endovascular therapy for unilateral peripheral artery disease (PAD).  Materials and methods: In this retrospective cohort study, 378 patients with unilateral PAD undergoing endovascular therapy and having baseline and 1-year follow-up CTA were included. Mid-thigh skeletal muscle cross-sectional area and whole-thigh muscle volume were quantified bilaterally with semi-automated software. Contralateral-controlled biomarkers (affected minus contralateral) were derived to isolate limb-specific ischemic effects. The primary endpoint was clinically driven 1-year restenosis (≥ 50%) confirmed by DSA.  Results: Among 378 patients, 162 (43%) developed restenosis at a median follow-up of 12.5 months. Contralateral-controlled muscle asymmetry was independently associated with restenosis after adjustment for lesion length, baseline stenosis degree, Fontaine stage, disease duration, and TASC II classification (OR 1.43, 95% CI: 1.08–1.89, p = 0.01). Adding muscle asymmetry to a severity-only model improved discrimination from AUC 0.76 to 0.79 (DeLong p = 0.04). A baseline predictive model combining lesion length and muscle asymmetry achieved AUC 0.74; a full explanatory model incorporating longitudinal muscle changes reached AUC 0.88, with the greatest net benefit on decision curve analysis.  Conclusion: Thigh muscle biomarkers, acquired opportunistically from routine CTA scans, improved the prediction of 1-year restenosis after endovascular therapy and may support targeted surveillance in patients with unilateral PAD.  Key Points: Question Can contralateral-controlled thigh muscle biomarkers on routine CT angiography improve the prediction of 1-year restenosis after endovascular therapy for unilateral peripheral artery disease?  Findings In 378 PAD patients, baseline contralateral thigh muscle asymmetry independently predicted clinically driven, DSA-confirmed restenosis and improved AUC from 0.76 to 0.79.  Critical relevance statement Opportunistic contralateral-controlled thigh muscle analysis on routine CT angiography provides a no-cost imaging biomarker that refines post-endovascular restenosis risk stratification, supporting targeted angiographic surveillance and advancing personalized vascular imaging practice in peripheral artery disease.
SN  - 1869-4101
ER  -