Comparison of Feasibility and Diagnostic Accuracy of 64-Slice Multidetector Computed Tomographic Coronary Angiography Versus Invasive Coronary Angiography Versus Intravascular Ultrasound for Evaluation of In-Stent Restenosis

Noninvasive assessment of coronary in-stent restenosis (ISR) is clinically useful but 4- and 16-slice multidetector computed tomography is limited due to stent strut artifacts. We evaluated the feasibility and accuracy of 64-slice multidetector computed tomography in the diagnosis of ISR to validate...

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Bibliographic Details
Published in:The American journal of cardiology 2009-05, Vol.103 (10), p.1349-1358
Main Authors: Andreini, Daniele, MD, Pontone, Gianluca, MD, Bartorelli, Antonio L., MD, Trabattoni, Daniela, MD, Mushtaq, Saima, MD, Bertella, Erika, MD, Annoni, Andrea, MD, Formenti, Alberto, MD, Cortinovis, Sarah, MD, Montorsi, Piero, MD, Veglia, Fabrizio, PhD, Ballerini, Giovanni, MD, Pepi, Mauro, MD
Format: Article
Language:English
Subjects:
Accuracy
Biological and medical sciences
Cardiology
Cardiology. Vascular system
Cardiovascular
Cardiovascular system
Coronary Angiography
Coronary Restenosis - diagnostic imaging
Feasibility Studies
Female
Heart
Humans
Image Interpretation, Computer-Assisted
Investigative techniques, diagnostic techniques (general aspects)
Male
Medical diagnosis
Medical sciences
Middle Aged
Predictive Value of Tests
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Sensitivity and Specificity
Stents
Tomography
Tomography, X-Ray Computed - methods
Transplants & implants
Ultrasonography, Interventional - methods
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Summary:Noninvasive assessment of coronary in-stent restenosis (ISR) is clinically useful but 4- and 16-slice multidetector computed tomography is limited due to stent strut artifacts. We evaluated the feasibility and accuracy of 64-slice multidetector computed tomography in the diagnosis of ISR to validate its accuracy in ISR quantification and identify factors that may affect stent patency evaluability. One hundred patients with previously implanted coronary stents (n = 179) underwent 64-slice multidetector computed tomography followed by invasive coronary angiography. After multidetector computed tomography, each stent was classified as “evaluable” or “unevaluable.” Obstructive ISR was visually and quantitatively determined in evaluable stents. Correlations between quantitative multidetector computed tomography and quantitative coronary angiography were estimated. In a subgroup, multidetector computed tomographic and intravascular ultrasound measurements were correlated. Feasibility of stent visualization was 95%. Thirty-four of 39 ISRs (87%) were correctly detected and localized by multidetector computed tomography. ISR was correctly ruled out for 77% (128 of 131) of remaining stented lesions. Sensitivity, specificity, and positive and negative predictive values of multidetector computed tomography for ISR identification were 87%, 98%, 92%, and 96%, respectively. There was good correlation between percent stenosis evaluated by multidetector computed tomography versus quantitative coronary angiography and intravascular ultrasound (r = 0.794, p
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2009.01.343