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Usefulness of multislice computed tomographic coronary angiography to assess in-stent restenosis

Filippo Cademartiri1, Nico Mollet, Pedro A Lemos

  • 1Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands. filippocademartiri@hotmail.com

The American Journal of Cardiology
|September 20, 2005
PubMed

Insights

Multislice computed tomographic coronary angiography effectively detects in-stent restenosis after stent implantation. This imaging technique shows high accuracy in identifying significant blockages within coronary stents.

Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Radiology

Background:

  • Coronary artery disease often requires stent implantation to restore blood flow.
  • In-stent restenosis remains a significant complication, necessitating accurate surveillance methods.
  • Multislice computed tomographic coronary angiography (MSCTCA) offers a non-invasive approach to evaluate coronary arteries.

Purpose of the Study:

  • To assess the diagnostic performance of MSCTCA in detecting in-stent restenosis (ISR) and occlusion in patients with previous stent implantation.
  • To compare the accuracy of MSCTCA against quantitative coronary angiography (QCA) for evaluating stented coronary segments.

Main Methods:

  • Fifty-one patients with prior stent implantation underwent MSCTCA.
  • Coronary branches >= 2.0 mm were analyzed by two independent observers for ISR (>= 50%) and occlusion.
  • Consensus MSCTCA findings were compared with QCA results.

Main Results:

  • Out of 74 evaluated stents, 6 (8.1%) showed significant disease (3 restenoses, 3 occlusions).
  • MSCTCA demonstrated a sensitivity of 83.3% and specificity of 98.5% for detecting ISR.
  • The positive predictive value was 83.3%, and the negative predictive value was 97.3%.

Conclusions:

  • MSCTCA is a highly specific and accurate non-invasive tool for evaluating in-stent restenosis and occlusion.
  • While MSCTCA shows excellent performance, one case of in-stent restenosis was missed, highlighting the need for continued vigilance.
  • MSCTCA can be a valuable method for post-stent implantation follow-up and management.

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