Comparison of 16-multidetector computed tomography versus invasive coronary angiography in the detection of coronary artery in-stent restenosis

الملخص EN

Objective: To evaluate the potential value of 16-slice multidetector computed tomography to non-invasively detect significant coronary in-stent restenosis.

Methods: During a period of 9 months (between 1/6/2005 to 22/3/2006), fifty patients (37 (74%) male, 13 (26%) female, mean age 57.8 ± 11.3 years) previously subjected to percutaneous implantation of coronary stents before mean of 7.8 ± 2.3 months, underwent a 16-row multidetector computed tomography for suspected in-stent restenosis.

The mean time between multidetector computed tomography and repeat invasive coronary angiography was 3.6 weeks.

The scan was completed in <20 seconds.

Multiplanar reconstructions were made for all stented coronary artery segments.

Stents were viewed in long and short axes and classified according to graded visual analysis of luminal contrast attenuation into either being patent (lumen reduction <50%) or having in-stent restenosis (lumen reduction ? 50%).

The diagnostic performance of multidetector computed tomography was evaluated with invasive coronary angiography serving as the standard of reference.

Results from the two angiographic techniques were compared after performing four separate analyses: First an in-stent analysis, second an in-segment analysis, third a patient-based analysis and lastly an in-stent analysis but after excluding stents with total in-stent occlusion (ISO).

The effects of stent length, diameter and strut thickness were also analyzed.

Results: A total of 80 stented coronary vessel segments were screened for in-stent restenosis using multidetector computed tomography and then compared with invasive coronary angiography.

In-stent restenosis (? 50% luminal narrowing by quantitative coronary angiography) was found on invasive coronary angiography in twenty one (26%) stented segments (13 restenoses and 8 total occlusions) in 18 (36%) patients.

The sensitivity, specificity, positive predictive value and negative predictive value of the multidetector computed tomography for the detection of coronary ISR were 71.4%, 88.1%, 68.2% and 89.7% respectively, compared to invasive coronary angiography restenosis.

This allowed confirmation of stent patency in 53/59 (89.7%) stents and correct identification of in-stent restenosis and occlusion in 15/21(71.4%) stents.

False negative results occurred in 6 (7.5%) stents and false positive results in another 6 (7.5%) stents.

Conclusion: In-stent restenosis can be diagnosed with moderate sensitivity using 16-row multidetector computed tomography.

The high negative predictive value implies a significant role in excluding in-stent restenosis.

Further improvements in spatial and temporal resolution of multidetector computed tomography are still required to challenge invasive angiography and become suitable for clinical implementation.