Insights Into Microcirculation Underlying Critical Limb Ischemia by Single-Photon Emission Computed Tomography

Spinal Cord Stimulation Improves the Microvascular Perfusion Insufficiency Caused by Critical Limb Ischemia

OBJECTIVE

This retrospective case-controlled study intended to identify the benefits and efficacy of spinal cord stimulation (SCS) as a therapeutic strategy for patients with perfusion problems caused by critical limb ischemia (CLI). The outcomes of patients who received SCS were compared with those of patients who did not receive SCS.

METHODS

This study recruited 78 patients who were diagnosed with perfusion problems over the period of 2003-2011. Lower-limb Thallium-201 (²⁰¹ Tl) scintigraphy revealed that the patients exhibited a perfusion difference of <0.95. Thirty-seven of the recruited patients received SCS treatment and 41 did not receive SCS treatment. All patients received the same medication: 100 mg aspirin once a day and 500 mg paracetamol thrice a day. The outcomes of walking distance, walking time, and sleeping quality were measured and recorded. Pain intensities were evaluated using the visual analog scale (VAS) scoring system.

RESULTS

Prior to SCS implantation, patients in the SCS treatment group had worse walking distance (64.86 ± 40.80 vs. 613.70 ± 535.00, p < 0.001), walking time (2.65 ± 1.64 vs. 13.90 ± 11.91, p < 0.001), and sleep quality (1.70 ± 0.78 vs. 3.32 ± 1.17, p < 0.001) than patients in the non-SCS treatment group. At the one-year follow-up, however, patients in the SCS treatment group had significantly better walking distance (1595.00 ± 483.60, p < 0.001), walking time (48.92 ± 14.10, p < 0.001), and sleep quality (4.65 ± 0.92, p < 0.001) than patients in the non-SCS treatment group. Moreover, the VAS score of patients in the SCS treatment group improved one week (8.63 ± 0.54 vs. 4.48 ± 0.59, p < 0.001) and one year after SCS implantation (2.35 ± 0.62, p < 0.001). By contrast, at the one-year follow-up, the walking distance (277.60 ± 374.80, p = 0.002), walking time (9.44 ± 10.73, p = 0.078), sleep quality (2.20 ± 1.10, p < 0.001), and VAS score (7.98 ± 0.43, p = 0.020) of patients in the non-SCS treatment group worsened. Furthermore, lower-limb ²⁰¹ Tl scintigraphy revealed that microcirculation intensity increased in the lower extremities of patients in the SCS treatment group after SCS implantation relative to that before SCS implantation. Most importantly, 10 of the 41 patients in the non-SCS treatment group required the use of wheelchairs, whereas none of the patients in the SCS treatment group required the use of wheelchairs.

CONCLUSION

Treatment of CLI patient with SCS improved patient's walking ability, pain severity, and sleep quality. SCS should be considered as an effective treatment toward limb salvage in CLI.

A novel use of hill function and utility of 99mTc-MIBI scintigraphy to detect earlier lower extremity microvascular perfusion in patients with type 2 diabetes

We use the Hill function to analyze the dynamics of Tc-99m 2 methoxy-isobutyl-isonitrile (Tc-MIBI) scintigraphy data and to examine the earlier lower extremity microvascular perfusion of diabetic patients without typical clinical symptoms and with the preserved normal ankle-brachial index (ABI).Eighty-eight participants (30 healthy control, 34 diabetic patients, and 24 diabetic patients with peripheral arterial disease [PAD]) were recruited and applied Tc-MIBI scintigraphy. Fourteen diabetic patients with PAD also underwent computed tomography angiography (CTA) examination and were performed endovascular interventions.Diabetic patients with normal ABI already have significantly impaired maximum Tc-MIBI muscle perfusion counts (P < .001) and the peak times of the lower extremity muscle perfusion (P < .05). Tc-MIBI scintigraphy showed great consistent with ABI and CTA in detecting PAD. Tc-MIBI scintigraphy was also found to be effective in evaluating lower extremity circulation after endovascular interventions (P < .05).Hill function-based analysis of Tc-MIBI scintigraphy might be effective method to evaluate earlier lower extremity perfusion changes in diabetic patients.