“We want to change global standards. What we’re doing isn’t working. Patients are getting hurt and devices are failing—we want to be able to make sure devices we’re using today are safe, so that we can build new devices that are going to meet our needs for tomorrow.”
This was the statement made by Trisha Roy, MD, from Houston Methodist Hospital in Houston, Texas, during a 2025 Vascular Annual Meeting (VAM) in New Orleans (June 4–7) talk on image-guided precision in peripheral arterial disease (PAD) management. Her talk introduced a novel magnetic resonance imaging (MRI) method aimed to turn “clinical failures into new innovations,” tackling the “often demoralizing” battle to save limbs in the treatment of chronic limb-threatening ischemia (CLTI).
Referencing Wednesday’s session titled “Who should not undergo endovascular treatment for CLTI,” Roy admitted that the average VAM attendee came away with “more questions than answers.” In her view, “a big problem [with treatment for CLTI] is that we’re making these life-altering decisions based on diagnostic angiograms that show you contrast in lumen, but nothing about plaque, its composition, or about how hard, soft or malleable [the lesion] is going to be. And I don’t think that’s acceptable in 2025.”
To address this, Roy described the three-pronged approach that she and her colleagues take to treating CLTI—see it, treat it, know it. First, Roy described her team’s novel MRI method that addresses which patients have problematic lesions in advance of treatment.
“CLTI is a medieval problem in modern medicine, even with imaging and endovascular treatment we still have a very high immediate technical failure rate, mostly due to an inability to cross the lesion,” said Roy. To provide lesion characteristic details to potentially address this failure rate, Roy and colleagues’ MRI method uses T2 weighted and ultra-short at-the-time imaging to provide “unique signatures that show you whether something is fat, thrombus, soft matrix or hard materials like collagen and calcium,” Roy explained.
“When we use this in our prospective patient study, MRI predicted endovascular failure, need for adjunctive devices and reintervention rates. I think it’s important because not only are you identifying modes of failure—or who’s going to be high risk—but you can plan your procedures and set yourself up for success by knowing what tools you need,” continued Roy.
Addressing their second pillar: treat it, Roy placed emphasis on using “failure as a blueprint for innovation.”
“You know, we have a lot—a lot—of tools at our disposal. We don’t really know how to choose them appropriately,” Roy stated. “We’ve had so many recent device recalls and failures and I think those were preventable.” She described her team’s peripheral vascular device core which tests “real devices in real patients to identify failure modes before they become clinical events.”
