Third-generation computed tomography angiography after coronary chronic total occlusion intervention in ruling out...

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• Invasive coronary angiography (ICA) is standard for stent patency assessment post-percutaneous coronary intervention (PCI), but carries risks.
• Third-generation coronary computed tomography angiography (CCTA) presents a non-invasive, safer alternative, yet real-world data are limited.
• Evaluating CCTA's efficacy in detecting in-stent restenosis (ISR) in long stents is crucial for clinical practice.

Purpose of the Study:

• To assess the diagnostic accuracy of third-generation CCTA in ruling out significant in-stent restenosis (ISR) in long coronary stents.
• To compare the safety and efficacy of CCTA versus ICA for long-term follow-up after PCI for coronary chronic total occlusion.

Main Methods:

• Prospective, single-centre study (NCT06543641) including 45 patients with long stents (≥30-38 mm) after PCI for chronic total occlusion.
• All patients underwent third-generation dual-source CCTA; ICA was performed for CCTA-detected ISR, inconclusive results, or symptomatic native artery lesions.
• Analysis focused on CCTA's ability to rule out significant ISR in long stents at long-term follow-up.

Main Results:

• CCTA successfully ruled out significant ISR in 87% (39/45) of patients with long stents.
• Six patients (13%) had CCTA findings suggestive of ISR or inconclusive results, all confirmed by ICA.
• ICA revealed significant stenosis in all six patients requiring invasive assessment.

Conclusions:

• Third-generation CCTA demonstrates high accuracy in ruling out significant ISR in long coronary stents.
• CCTA offers a non-invasive, lower-risk alternative for long-term surveillance of patients with long stents post-PCI.
• This imaging modality enhances patient safety by reducing the need for invasive procedures.