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Updated: Jul 3, 2026
Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
Published on: September 14, 2009
Multidetector computed tomography angiography for assessment of in-stent restenosis: meta-analysis of diagnostic
Piet K Vanhoenacker1, Isabel Decramer, Olivier Bladt
1Department of Radiology and Imaging, OLV Ziekenhuis, Aalst, Belgium. piet@vanhoenacker.be
Insights
Multi-detector computed tomography angiography (MDCTA) shows insufficient sensitivity for detecting in-stent restenosis. Further scanner technology improvements are needed before MDCTA can be a reliable triage tool for coronary artery stenting.
Area of Science:
- Cardiovascular imaging
- Interventional cardiology
- Radiology
Background:
- Multi-detector computed tomography angiography (MDCTA) is increasingly used for coronary artery assessment post-stenting.
- Previous studies have evaluated MDCTA's diagnostic performance for in-stent restenosis (ISR).
Purpose of the Study:
- To conduct a structured review and meta-analysis.
- To assess the diagnostic performance of MDCTA in detecting coronary in-stent restenosis.
Main Methods:
- A comprehensive literature search was performed using PubMed and manual methods.
- Bivariate summary receiver operating curve (SROC) analysis was used for diagnostic performance estimation.
- Logistic meta-regression investigated the impact of study characteristics on performance and non-assessable segments.
Main Results:
- Fourteen studies were included in the analysis.
- Pooled sensitivity was 0.82 and specificity was 0.91 on a stent basis.
- Study characteristics like stent strut thickness and non-assessable stent proportion influenced diagnostic performance.
Conclusions:
- MDCTA's sensitivity for in-stent restenosis is currently insufficient for selecting patients for invasive testing, potentially missing 20% of cases.
- A high proportion of non-assessable stents remains a concern.
- Advancements in scanner technology are necessary for MDCTA to be a practical triage instrument.
Background:
Multi-detector computed tomography angiography (MDCTA)of the coronary arteries after stenting has been evaluated in multiple studies.The purpose of this study was to perform a structured review and meta-analysis of the diagnostic performance of MDCTA for the detection of in-stent restenosis in the coronary arteries.
Methods:
A Pubmed and manual search of the literature on in-stent restenosis (ISR) detected on MDCTA compared with conventional coronary angiography (CA) was performed. Bivariate summary receiver operating curve (SROC) analysis, with calculation of summary estimates was done on a stent and patient basis. In addition, the influence of study characteristics on diagnostic performance and number of non-assessable segments (NAP) was investigated with logistic meta-regression.
Results:
Fourteen studies were included. On a stent basis, Pooled sensitivity and specificity were 0.82(0.72-0.89) and 0.91 (0.83-0.96). Pooled negative likelihood ratio and positive likelihood ratio were 0.20 (0.13-0.32) and 9.34 (4.68-18.62) respectively. The exclusion of non-assessable stents and the strut thickness of the stents had an influence on the diagnostic performance. The proportion of non-assessable stents was influenced by the number of detectors, stent diameter, strut thickness and the use of an edge-enhancing kernel.
Conclusion:
The sensitivity of MDTCA for the detection of in-stent stenosis is insufficient to use this test to select patients for further invasive testing as with this strategy around 20% of the patients with in-stent stenosis would be missed. Further improvement of scanner technology is needed before it can be recommended as a triage instrument in practice. In addition, the number of non-assessable stents is also high.
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