Multislice spiral computed tomography for the evaluation of stent patency after left main coronary artery stenting: a...

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Radiology

Background:

• Conventional coronary angiography (CCA) is recommended post-stent-supported left main coronary artery (LMCA) percutaneous coronary intervention (PCI) to monitor for in-stent restenosis (ISR).
• Multislice computed tomography (MSCT) offers a noninvasive approach for coronary evaluation.
• The diagnostic performance of high-resolution MSCT for detecting ISR after LMCA stenting requires assessment.

Purpose of the Study:

• To evaluate the diagnostic accuracy of high-resolution MSCT in detecting in-stent restenosis (ISR) after left main coronary artery (LMCA) stenting.
• To compare MSCT findings with conventional coronary angiography (CCA) and intravascular ultrasound (IVUS).

Main Methods:

• Seventy-four patients undergoing follow-up CCA after LMCA stenting were prospectively evaluated using MSCT prior to CCA.
• A 16-slice scanner was used initially, followed by a 64-slice scanner.
• Heart rate control was implemented using beta-blockers, achieving a mean heart rate of 57 bpm.

Main Results:

• Among 70 technically adequate scans, MSCT correctly identified all 10 cases of ISR and misclassified 5 non-ISR cases, yielding an overall accuracy of 93%.
• Sensitivity, specificity, and negative predictive value were 100%, 91%, and 100%, respectively.
• Accuracy was higher for LMCA stenting without bifurcation involvement (98%) compared to bifurcation stenting (83%). MSCT showed good correlation with IVUS for stent dimensions (r=0.78-0.73).

Conclusions:

• High-resolution MSCT, with optimal heart rate control, enables reliable noninvasive assessment of selected patients post-LMCA stenting.
• MSCT is a safe tool for excluding left main ISR and can be considered a viable first-line alternative to CCA.