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Background: Quiescent‐interval slice‐selective (QISS) magnetic resonance angiography (MRA) is a non‐contrast alternative for the pre‐procedural assessment of patients with peripheral artery disease (PAD). However, the feasibility of pre‐procedural stent size estimation using QISS MRA would merit investigation. Purpose To evaluate the feasibility of QISS MRA for pre‐procedural stent size estimation in PAD patients compared to computed tomography angiography (CTA). Study Type: Retrospective. Subjects: Thirty‐three PAD patients (68 ± 9 years, 18 men, 15 women). Field Strength/Sequence: Two‐dimensional balanced steady‐state free precession QISS MRA at 1.5 T and 3 T. Assessment All patients received QISS MRA and CTA of the lower extremity run‐off followed by interventional digital subtraction angiography (DSA). Stenotic lesion length and diameter were quantified (AMF and AVS with 3 and 13 years of experience in cardiovascular imaging, respectively) to estimate the dimensions of the stent necessary to restore blood flow in the treated arteries. Measured dimensions were adjusted to the closest stent size available. Statistical Tests: The Friedman test with subsequent pairwise Wilcoxon signed‐rank test was used to compare the estimated stent dimensions between QISS MRA, CTA, and the physical stent size used for intervention. Intra‐class correlation (ICC) analysis was performed to assess inter‐reader agreement. Significant differences were considered at P < 0.05. Results: No significant difference was observed between estimated stent diameter by QISS MRA or CTA compared to physical stent diameter (8.9 ± 2.9 mm, 8.8 ± 3.0 mm, and 8.8 ± 3.8 mm, respectively; χ2 = 1.45, P = 0.483). There was a significant underestimation of stent length for both QISS MRA and CTA, compared to physical stent length (45.8 ± 27.8 mm, 46.4 ± 29.3 mm, and 50.4 ± 34.0 mm, respectively; χ2 = 11.96) which could be corrected when measurements were adjusted to the next available stent length (χ2 = 2.38, P = 0.303). Inter‐reader assessment showed good to excellent agreement between the readers (all ICC ≥0.81). Data Conclusion: QISS MRA represents a reliable method for pre‐procedural lesion assessment and stent diameter and length estimation in PAD patients. Level of Evidence: 3 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Objectives This study sought to evaluate the image quality and diagnostic accuracy of noncontrast quiescent-interval single-shot (QISS) magnetic resonance angiography (MRA) versus iodine-contrast computed tomography angiography (CTA) in patients with peripheral artery disease (PAD), with invasive digital subtraction angiography (DSA) as the reference standard. Background QISS is a recently introduced noncontrast MRA technique. Although the diagnostic accuracy of QISS is reportedly similar to that of contrast-enhanced MRA, its performance compared with contrast-enhanced CTA, the most frequently used noninvasive modality for evaluation of PAD, is unknown. Methods Thirty patients (66 ± 7 years of age) with PAD underwent lower extremity CTA with third-generation dual-source dual-energy CT and 1.5-T MRA using a prototype noncontrast QISS sequence. DSA was performed within 50 days. The abdominal aorta and lower extremity run-off were imaged. Eighteen arterial segments were analyzed. Subjective image quality (3-point Likert scale) and stenosis (5-point grading) were evaluated by 2 observers and compared using the Mann–Whitney U and chi-square tests, respectively. Sensitivity and specificity of MRA and CTA for >50% stenosis detection were compared using the McNemar-test. Results Of 540 segments, 15 (2.8%) and 42 (7.8%) inconclusive segments were excluded from MRA and CTA analysis, respectively (p = 0.0006). The DSA results were available for 410 of the remaining segments. Overall subjective image quality was rated similarly with QISS-MRA (2.52 [95% confidence interval: 2.46 to 2.57]) and CTA (2.49 [95% confidence interval: 2.43 to 2.55]; p = 0.5062). The sensitivity and specificity of MRA for >50% stenosis were 84.9% and 97.2%, respectively, similar to those of CTA (87.3% and 95.4%, respectively). Interobserver agreement for stenosis detection was excellent for MRA (κ > 0.81) and CTA (κ > 0.81). Conclusions Noncontrast QISS-MRA provides high diagnostic accuracy compared with DSA, while being less prone to image artifacts than CTA. QISS better visualizes heavily calcified segments with impaired flow. QISS-MRA obviates the need for contrast administration in PAD patients. [ABSTRACT FROM AUTHOR]

Importance: Two initial sham-controlled trials demonstrated that ultrasound renal denervation decreases blood pressure (BP) in patients with mild to moderate hypertension and hypertension that is resistant to treatment., Objective: To study the efficacy and safety of ultrasound renal denervation without the confounding influence of antihypertensive medications in patients with hypertension., Design, Setting, and Participants: Sham-controlled, randomized clinical trial with patients and outcome assessors blinded to treatment assignment that was conducted between January 14, 2019, and March 25, 2022, at 37 centers in the US and 24 centers in Europe, with randomization stratified by center. Patients aged 18 years to 75 years with hypertension (seated office systolic BP [SBP] ≥140 mm Hg and diastolic BP [DBP] ≥90 mm Hg despite taking up to 2 antihypertensive medications) were eligible if they had an ambulatory SBP/DBP of 135/85 mm Hg or greater and an SBP/DBP less than 170/105 mm Hg after a 4-week washout of their medications. Patients with an estimated glomerular filtration rate of 40 mL/min/1.73 m2 or greater and with suitable renal artery anatomy were randomized 2:1 to undergo ultrasound renal denervation or a sham procedure. Patients were to abstain from antihypertensive medications until the 2-month follow-up unless prespecified BP criteria were exceeded and were associated with clinical symptoms., Interventions: Ultrasound renal denervation vs a sham procedure., Main Outcomes and Measures: The primary efficacy outcome was the mean change in daytime ambulatory SBP at 2 months. The primary safety composite outcome of major adverse events included death, kidney failure, and major embolic, vascular, cardiovascular, cerebrovascular, and hypertensive events at 30 days and renal artery stenosis greater than 70% detected at 6 months. The secondary outcomes included mean change in 24-hour ambulatory SBP, home SBP, office SBP, and all DBP parameters at 2 months., Results: Among 1038 eligible patients, 150 were randomized to ultrasound renal denervation and 74 to a sham procedure (mean age, 55 years [SD, 9.3 years]; 28.6% female; and 16.1% self-identified as Black or African American). The reduction in daytime ambulatory SBP was greater with ultrasound renal denervation (mean, -7.9 mm Hg [SD, 11.6 mm Hg]) vs the sham procedure (mean, -1.8 mm Hg [SD, 9.5 mm Hg]) (baseline-adjusted between-group difference, -6.3 mm Hg [95% CI, -9.3 to -3.2 mm Hg], P < .001), with a consistent effect of ultrasound renal denervation throughout the 24-hour circadian cycle. Among 7 secondary BP outcomes, 6 were significantly improved with ultrasound renal denervation vs the sham procedure. No major adverse events were reported in either group., Conclusions and Relevance: In patients with hypertension, ultrasound renal denervation reduced daytime ambulatory SBP at 2 months in the absence of antihypertensive medications vs a sham procedure without postprocedural major adverse events., Trial Registration: ClinicalTrials.gov Identifier: NCT03614260.

Background: Numerous clinical trials conducted 10-20 years ago evaluated contrast-induced discomfort. It is unknown whether those data are applicable to current-day clinical practice. This study was performed to provide contemporary contrast-induced patient discomfort data obtained during peripheral arteriography procedures using iso-osmolar iodixanol 320 mg I/mL, compared to low-osmolar iopamidol 370 mg I/mL., Methods and Results: Patients receiving iodixanol or iopamidol reported discomfort (heat, coldness, or pain) using a 10-point scale, which was converted to intensity categories: 0 = none; 1-3 = mild; 4-7 = moderate; and 8-10 = severe. Image diagnostic quality was assessed. Patients receiving iodixanol (n = 127; 61% male; mean age, 64 years) had less moderate/severe discomfort (67.7% vs 84.0%; P=.01) than those receiving iopamidol (n = 126; 64% male; mean age, 62 years), with pain contributing predominantly (7.3% vs 44.0%; P<.001) for all injection scores. Patients receiving iodixanol experienced less severe discomfort (16.9% vs 46.4%; P<.001), heat (15.3% vs 36.8%; P<.001), and pain (2.4% vs 23.2%; P<.001) for all injections, compared with patients receiving iopamidol. Image quality was rated as excellent in most patients (iodixanol 86.5% vs iopamidol 82.4%; P=.57). Treatment-emergent adverse events were similar between groups (iodixanol 18.9% vs iopamidol 11.9%; P=.16)., Conclusions: Iodixanol injections induced significantly less moderate/severe and severe patient discomfort, heat, or pain than iopamidol, with pain contributing the most. Discomfort did not affect image quality.