In Vivo Evaluation of Stent Patency by 64-Slice Multidetector CT Coronary Angiography: Shall We Do It or Not?

OBJECTIVES: The diagnostic performance of in-stent restenosis (ISR) by 64-slice multidetector CT coronary angiography (CTCA) has been reported to be influenced by multiple factors. We evaluated individual factors (stent diameter, material and strut thickness) and therefore determined the proper population for follow-up by using this modality.

METHODS: A total of 171 stents were evaluated in 83 consecutive patients with stents imaged with CTCA and conventional coronary angiography. The stent diameter ranged from 2.25 mm to 4.5 mm. 2 models of stainless steel (Taxus Liberte (Boston Scientific, US), 56 stents and Cypher Select (Cordis, US), 34 stents) and

</div 2 models of cobalt alloy (Endeavor (Medtronic, US), 33 stents and Firebird2 (MicroPort, China), 48 stents) were included. By comparing to conventional coronary angiography, the image quality and diagnostic accuracy for ISR were evaluated.

RESULTS: The image quality of Taxus, Endeavor and Firebird are markedly better than Cypher in large caliber group (≧3.0 mm) (P < 0.001). Except for Cypher, all other stents with diameter ≧3.0 mm showed excellent diagnostic accuracy (sensitivity 100%, specificity 94.4-96% whereas stents with diameter <3.0 mm had poor diagnostic accuracy (sensitivity 100%, specificity 33.3-70%). Cypher is the stent with thickest strut in our study, and showed reduced image quality and diagnostic accuracy in all stent size, due to large number of unassessable stents. Among 16 binary ISR, 12 lesions were correctly diagnosed by CTCA while the other 4 lesions were unassessable. The main reason for low specificity in small caliber group is the large number of unassessable stents.

CONCLUIONS: CTCA has high diagnostic accuracy to identify ISR in selected stents with a diameter of ≧3.0 mm. Brett Maher Authentic Jersey

PMID: 21461883

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  1. The following bilingual abstract is provided by the authors:

    目的 64层螺旋CT冠状动脉成像(CTCA)诊断支架内再狭窄(ISR)的准确性受多方面因素的影响。本研究通过分析不同因素(支架直径、材料和支架壁厚度)对诊断准确性的影响,以明确适合CTCA随访的患者群。
    方法和材料 连续性入组83名PCI术后患者(171枚支架),同时接受CTCA和CAG检查。支架直径范围为2.25mm至4.5mm,包含2类不锈钢支架(Taxus Liberte (Boston Scientific, US), 56枚,Cypher Select (Cordis, US),34枚)和2类钴合金支架(Endeavor (Medtronic, US),33 枚,Firebird2 (MicroPort, China),48枚)。通过与CAG的比较,评估不同直径、不同类型支架的CTCA图像质量与诊断准确性。
    结果 大直径组(≧ 3.0mm)中,Taxus, Endeavor和Firebird支架的图像质量显著优于Cypher(p<0.001)。除了Cypher以外,所有直径≧ 3.0mm支架的诊断准确性良好(敏感性100%,特异性94.4%-96%),而直径< 3.0mm支架的诊断准确性较差(敏感性100%,特异性33.3%-70%)。Cypher具有本研究中最厚的支架壁,其图像质量不佳,无法分析的支架数目多,因而诊断准确性低。在所有16处≧50%的ISR中,CTCA准确诊断了12处;另有4处的支架图像无法分析。小直径支架组中,诊断特异性低的最主要原因为无法分析的支架数较多。
    结论 在直径≧ 3.0mm的部分类型的支架中,CTCA诊断ISR的准确性高。

    Purpose: The diagnostic performance of in-stent restenosis (ISR) by 64-slice multidetector CT coronary angiography (CTCA) has been reported to be influenced by multiple factors. We evaluated individual factors (stent diameter, material and strut thickness) and therefore determined the proper population for follow-up by using this modality.
    Methods and Materials: A total of 171 stents were evaluated in 83 consecutive patients with stents imaged with CTCA and conventional coronary angiography. The stent diameter ranged from 2.25mm to 4.5mm. 2 models of stainless steel (Taxus Liberte (Boston Scientific, US), 56 stents and Cypher Select (Cordis, US), 34 stents) and 2 models of cobalt alloy (Endeavor (Medtronic, US), 33 stents and Firebird2 (MicroPort, China), 48 stents) were included. By comparing to conventional coronary angiography, the image quality and diagnostic accuracy for ISR were evaluated.
    Results: The image quality of Taxus, Endeavor and Firebird are markedly better than Cypher in large caliber group (≧ 3.0mm) (p<0.001). Except for Cypher, all other stents with diameter ≧ 3.0mm showed excellent diagnostic accuracy (sensitivity 100%, specificity 94.4%-96% whereas stents with diameter <3.0 mm had poor diagnostic accuracy (sensitivity 100%, specificity 33.3%-70%). Cypher is the stent with thickest strut in our study, and showed reduced image quality and diagnostic accuracy in all stent size, due to large number of unassessable stents. Among 16 binary ISR, 12 lesions were correctly diagnosed by CTCA while the other 4 lesions were unassessable. The main reason for low specificity in small caliber group is the large number of unassessable stents.
    Conclusion: CTCA has high diagnostic accuracy to identify ISR in selected stents with a diameter of ≧ 3.0mm.

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