Multidetector Computed Tomography Coronary Angiography for the Assessment of Coronary In-Stent Restenosis

OBJECTIVES:The investigators conducted a review to evaluate the diagnostic performance of multidetector computed tomography (MDCT) for coronary stent evaluation.

METHODS: The prespecified inclusion criteria selected prospective or retrospective human studies published in English. Studies that did not report raw numbers of diagnostic accuracy for the detection of in-stent restenosis were excluded.

RESULTS: The data from 24 studies are reported, 6 performed with old-generation scanners (4-, 16-, and 40-slice MDCT) and 18 performed with 64-slice MDCT or dual-source MDCT. With old-generation MDCT, up to 18% of coronary stents were missed, the rate of nonevaluable stents ranged from 2.6% to 23.5%, and the overall feasibility and diagnostic accuracy were 90.4% and 90%, respectively. With 64-slice MDCT, no stent was missed, and the overall feasibility and diagnostic accuracy were 90.4% and 91.9%, respectively.
 

PMID:

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4 Comments

  1. An interesting review summarizing a somewhat controversial area. In my opinion, excluding or diagnosing in-stent restenosis is significantly more challenging than other clinical scenarios.

  2. Also see:

    Assessment of In-Stent Restenosis Using 64-MDCT: Analysis of the CORE-64 Multicenter International Trial.
    Joanna J. Wykrzykowska, Armin Arbab-Zadeh, Gustavo Godoy, Julie M. Miller, Shezhang Lin, Andrea Vavere, Narinder Paul, Hiroyuki Niinuma, John Hoe, Jeffrey Brinke, Faisal Khosa, Sheryar Sarwar, Joao Lima, Melvin E. Clouse.
    AJR 2010; 194:85–92.
    PMID:

  3. This is a very well presented structured review of the available literature on MDCT performance to assess in-stent restenosis, including 18 papers using 64-MDCT or DSCT equipment.

    As one would have expected, stent diameter and strut thickness played a role in luminal evaluation. One unexpected finding (in my opinion) was that there is no significant difference between stents with open or closed cell designs (as evaluated in 2 of the studies reviewed).

    The authors say it best: “The non-invasive evaluation of coronary stents is an attractive clinical challenge.”

  4. See also:

    Evaluation of coronary stents and stenoses at different heart rates with dual source spiral CT (DSCT).
    Lell MM, Panknin C, Saleh R, Sayre JW, Schmidt B, Dinh H, Ruehm SG.
    Invest Radiol. 2007 Jul;42(7):536-41.
    PMID:

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