Evidence mapPaperPMID 42275686Full record

ArticleJACC. Advances2026

Pathological Insights Into the Relationship Between Medial and Intimal Calcification in Lower Extremity Artery Disease.

Tsukasa Kato, Sho Torii, Manabu Shiozaki, Norihito Nakamura, Kazuki Aihara, Yu Sato, Yuki Matsumoto, Yuta Terabe, Osamu Iida, Takahiro Tokuda and 10 more

Abstract read
In one paragraph

Article in JACC. Advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Tsukasa KatoDepartment of Cardiology, Akita University School of Medicine, Akita, Japan; Department of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Sho ToriiDepartment of Cardiology, Tokai University School of Medicine, Isehara, Japan. Electronic address: shoz3333@gmail.com.
Manabu ShiozakiDepartment of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Norihito NakamuraDepartment of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Kazuki AiharaDepartment of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Yu SatoDepartment of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Yuki MatsumotoDepartment of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Yuta TerabeLimb Salvage Center, Kasukabe Chuo General Hospital, Kasukabe, Japan.
Osamu IidaCardiovascular Division, Osaka Keisatsu Hospital, Osaka, Japan.
Takahiro TokudaDepartment of Cardiology, Nagoya Heart Center, Nagoya, Japan.
Tomohiro IwataDepartment of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Hikaru OnishiDepartment of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Kaho HashimotoDepartment of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Ryosuke OmuraDepartment of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Daiki SuzukiDepartment of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Yuto OnoDepartment of Cardiology, Akita University School of Medicine, Akita, Japan.
Ken MiuraDepartment of Cardiology, Akita University School of Medicine, Akita, Japan.
Hiroyuki WatanabeDepartment of Cardiology, Akita University School of Medicine, Akita, Japan.
Yuji IkariDepartment of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Gaku NakazawaDepartment of Cardiology, Kindai University Faculty of Medicine, Osaka, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMedial artery calcification (MAC) is a hallmark of lower extremity artery disease, yet its precise distribution and relationship with intimal artery calcification (IAC) remain poorly understood because current clinical imaging modalities have limited ability to reliably distinguish between the 2.

objectivesThe objectives of the study were to comprehensively characterize the histopathological distribution and morphology of MAC and to determine its spatial relationship with intimal atherosclerotic plaque.

methodsWe performed a systematic, section-by-section histopathological analysis of 3,566 cross-sections from 125 arterial segments in 58 patients with lower extremity artery disease. Calcification was quantified by circumferential arc, and plaque morphology was classified according to the modified American Heart Association criteria.

resultsMAC was highly prevalent (91.2% of segments) and significantly more extensive in below-the-knee than above-the-knee arteries, whereas IAC demonstrated the opposite distribution. Medial bone formation was identified in 16.0% of segments and was strongly associated with the greatest MAC burden, representing an advanced stage of the disease. In a section-level analysis (n = 3,003), the arcs of MAC and IAC were inversely correlated (r = -0.47; P < 0.0001) and showed minimal circumferential overlap, indicating distinct spatial segregation. Sections with extensive MAC were primarily associated with nonatherosclerotic intima, whereas advanced intimal plaques occurred predominantly in sections with minimal MAC.

conclusionsMAC and IAC represent spatially distinct calcific pathologies with an inverse quantitative relationship. Advanced MAC may be associated with reduced development of intimal atherosclerotic plaque and may partly explain the limited response of below-the-knee lesions to conventional endovascular therapies.

Indexed as

bone formationchronic limb-threatening ischemiaintimal artery calcificationlower extremity artery diseasemedial artery calcification

Identifiers

PMID42275686
PMCPMC13276343

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.