Aortic & peripheral vascular diseaseResearch article
Pathological Insights Into the Relationship Between Medial and Intimal Calcification in Lower Extremity Artery Disease
- systematic, section-by-section histopathological analysis
Authors' conclusion
MAC 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.
Study context
- Population
- Patients with lower extremity artery disease3,566 cross-sections from 125 arterial segments
- Participants
- 58 patients
- Comparison
- Medial artery calcification (MAC) vs intimal artery calcification (IAC) distribution and spatial relationship; below-the-knee vs above-the-knee arteries
Main finding
As reported in the abstract
MAC prevalence
MAC prevalence (segments)
91.2%
Further findings
Medial bone formation
- Medial bone formation (segments)
- 16.0%
- Strongly associated with the greatest MAC burden
Correlation of MAC and IAC arcs (section-level)
- r
- −0.47
- P
- P < 0.0001
- Minimal circumferential overlap
- section-level analysis (n = 3,003)
Plaque morphology by MAC extent
- Sections with extensive MAC primarily associated with nonatherosclerotic intima; advanced intimal plaques predominantly in sections with minimal MAC
Original publication
Pathological Insights Into the Relationship Between Medial and Intimal Calcification in Lower Extremity Artery Disease. JACC Adv. Published 11 June 2026. doi:10.1016/j.jacadv.2026.102882
Summarised from the published abstract; every number is checked against it