While only 58% of stented lesions were evaluable by 64-slice MDCT, diagnostic accuracy in evaluable stents was high, with 86% sensitivity and 98% specificity for detecting restenosis.
Observational (n=64)
Does 64-slice MDCT accurately detect in-stent restenosis compared to invasive quantitative coronary angiography in patients with previously implanted coronary stents?
While 64-slice MDCT has high diagnostic accuracy for detecting in-stent restenosis in evaluable stents, its overall clinical utility is limited by a low rate of stent evaluability (58%).
Effect estimate: Sensitivity 86%, Specificity 98% (in evaluable stents) (95% CI 42-99% (sensitivity), 88-100% (specificity))
AIMS: We investigated the feasibility of assessing coronary artery stent restenosis using a new generation 64-slice multi-detector computed tomography-scanner (MDCT) in comparison to conventional quantitative angiography. METHODS AND RESULTS: MDCT was performed in 64 consecutive patients (mean age 58+/-10 years) with previously implanted coronary artery stents (102 stented lesions: mean stent diameter 3.17+/-0.38 mm). Each stent was classified as 'evaluable' or 'unevaluable', and in evaluable stents, the presence of in-stent restenosis (diameter reduction >50%) was determined visually. Results were verified against invasive, quantitative coronary angiography. Fifty-nine stented lesions (58%) were classified as evaluable in MDCT. The mean diameter of evaluable stents was 3.28+/-0.40 mm, whereas the mean diameter of non-evaluable stents was 3.03+/-0.31 mm (P=0.0002). Overall, six of 12 in-stent restenoses were correctly detected by MDCT 50% sensitivity (confidence interval 22-77%) and in 51 of 90 lesions, in-stent restenosis was correctly ruled out 57% specificity (46-67%). In evaluable stents, six of seven in-stent restenoses were correctly detected, and the absence of in-stent stenosis was correctly identified in 51 of 52 cases sensitivity 86% (42-99%) and specificity 98% (88-100%). CONCLUSION: Stent type and diameter influence evaluability concerning in-stent restenosis by MDCT. The rate of assessable stents is low, but in evaluable stents, accuracy for detection of in-stent restenosis can be high.
Rixe et al. (Mon,) conducted a observational in Coronary artery stent restenosis (n=64). 64-slice multi-detector computed tomography (MDCT) vs. Invasive quantitative coronary angiography was evaluated on Detection of in-stent restenosis (diameter reduction >50%) (Sensitivity 86%, Specificity 98% (in evaluable stents), 95% CI 42-99% (sensitivity), 88-100% (specificity)). While only 58% of stented lesions were evaluable by 64-slice MDCT, diagnostic accuracy in evaluable stents was high, with 86% sensitivity and 98% specificity for detecting restenosis.