Evaluating Calcification in Below-the-Knee Lesions Using Adjusted Computed Tomography Window Settings

True full-moon calcifications predict procedural failure in BTK EVT and unsuccessful antegrade guidewire passage in CTO cases. Noncontrast CT evaluation with artifact reduction may aid in procedural planning and treatment strategy.Clinical ImpactThis study clarifies the clinical significance of true full-moon calcifications in below-the-knee endovascular therapy (EVT). Applying artifact reduction techniques in noncontrast CT allows for more accurate assessment of severely calcified plaques. Identifying high-risk lesions preoperatively may help anticipate wire crossing or device delivery difficulties and guide strategy optimization. These findings may support improving procedural success in EVT for patients with critical limb-threatening ischemia (CLTI) who have complex lesions, including severe calcification and chronic total occlusion (CTO). This study demonstrates the clinical value of noncontrast CT in preprocedural lesion assessment and treatment planning in peripheral interventions.