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Myocardial perfusion scintigraphy to evaluate patients after coronary stent implantation
I Kósa1, R Blasini, J Schneider-Eicke
1Medizinische Klinik I, Klinikum rechts der Isar, der Technischen Universität, München, Germany.
Insights
Stress perfusion imaging accurately detects coronary stent restenosis. This method is most effective for patients without prior myocardial infarction in the stented area, aiding in patient management.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Coronary stent implantation is a common revascularization technique.
- Restenosis rates after stenting range from 20%-30% within six months, necessitating close patient follow-up.
- Limited data exists on the role of perfusion scintigraphy in managing post-stent patients.
Purpose of the Study:
- To evaluate the diagnostic performance of stress myocardial perfusion imaging.
- To assess its accuracy in detecting restenosis in patients who have undergone coronary stent implantation.
Main Methods:
- 82 patients underwent 93 rest/stress SPECT studies using 201Tl and 99mTc-MIBI.
- Studies evaluated 99 vascular territories with implanted coronary stents.
- Restenosis was defined by stress-induced perfusion defects with rest reversibility.
Main Results:
- Coronary angiography identified significant stenosis (>50%) in 19 arteries; 80 showed no restenosis.
- Perfusion scintigraphy detected restenosis in 15/19 territories (79% sensitivity) and correctly identified non-restenosis in 62/80 (78% specificity).
- Accuracy was highest in patients without prior myocardial infarction (100% sensitivity, 82% specificity).
Conclusions:
- Stress perfusion SPECT, using defect reversibility, accurately detects coronary artery stent restenosis.
- The imaging method demonstrates highest accuracy in stented territories without prior myocardial infarction.
- This technique can aid in the management of patients post-coronary stenting.
Unlabelled:
Coronary stent implantation is an increasingly accepted revascularization method. The 20%-30% restenosis rate during the first 6 mo requires a close follow-up of the patients. Since there is very little data available defining the role of perfusion scintigraphy in the management of this population, the aim of this study was to assess the diagnostic performance of stress myocardial perfusion imaging for detecting restenosis in patients after coronary stent implantation.
Methods:
In 82 patients, 93 rest or stress SPECT studies were performed using 201Tl and 99mTc-hexakis-2-methoxyisobutyl isonitrile to evaluate 99 vascular territories with implanted coronary stents. The average interval between the stent implantation and the scintigraphic study was 210.5 +/- 129.6 days. The scintiscans were visually evaluated. A stress-induced perfusion defect with reversibility at rest was used as the criterion for stent restenosis.
Results:
Coronary angiography revealed a stenosis of > 50% diameter in the region of the stent in 19 arteries, while in 80 arteries there was no evidence of restenosis angiographically. With perfusion scintigraphy, 15/19 vascular territories with restenosed stents showed stress-induced perfusion abnormalities (sensitivity = 79%), while 62/80 territories without restenosis did not (specificity = 78%). In territories without a myocardial infarction (n = 48), sensitivity and specificity values were 8/8 (100%) and 36/44 (82%), and in territories with a myocardial infarction (n = 47) 7/11 (64%) and 26/36 (72%), respectively. Side branch stenosis was fairly frequent in patients without stent restenosis but with a reversible perfusion pattern on their scintiscan (8/18); however, these stenoses were induced infrequently by the stents (3 cases).
Conclusion:
Using the criterion of defect reversibility, stress perfusion SPECT can accurately detect restenoses of coronary artery stents. This method is most accurate for evaluating patients without a previous myocardial infarction in the stented vascular territory.