Key result
CCTA accurately detects in-stent restenosis with ~90% per-stent sensitivity.
Why the study?
Does CCTA or CCTA+CTP accurately detect in-stent restenosis in patients with clinically suspected ISR compared to invasive angiography?
Meta-Analysis
Does CCTA or CCTA+CTP accurately detect in-stent restenosis in patients with clinically suspected ISR compared to invasive angiography?
CCTA and CCTA+CTP demonstrate high diagnostic accuracy for evaluating in-stent restenosis, suggesting previous stent implantation should not preclude their use in suspected patients.
AIMS: The objective of this study is to conduct a meta-analysis to assess the diagnostic performance of Coronary Computed Tomography Angiography (CCTA) and a hybrid approach that incorporates Computed Tomography Perfusion (CTP) in addition to CCTA (CCTA + CTP) for the detection of in-stent restenosis (ISR), as defined by angiography. METHODS: A comprehensive search of articles identified 18,513 studies. After removing duplicates, title/abstract screening, and full-text review, 17 CCTA and 3 CCTA + CTP studies were included. Only studies using ≥64-slices multidetector computed tomography (CT) were considered eligible. RESULTS: The per-patient ISR prevalence was 43 %, with 92 % of stents fully interpretable with CCTA. Meta-analysis exhibited a per-stent CCTA (n = 2674) sensitivity of 90 % (95 % CI; 84-94 %), specificity of 89 % (95 % CI; 86-92 %), positive likelihood ratio of 7.17 (95 % CI; 5.24-9.61), negative likelihood ratio of 0.17 (95 % CI; 0.10-0.25), and diagnostic odds ratio of 45.7 (95 % CI; 22.71-82.43). Additional sensitivity analyses revealed no influence of stent diameter or strut thickness on the diagnostic yield of CCTA. The per-stent diagnostic performance of CCTA + CTP (n = 752) did not show differences compared to CCTA. CONCLUSIONS: With currently utilized scanners, CCTA and CCTA + CTP demonstrated high diagnostic performance for in-stent restenosis evaluation. Consequently, a history of previous stent implantation should not be an argument to preclude using these methods in clinically suspected patients.
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Dahdal et al. (2024) conducted a meta-analysis in Clinically suspected in-stent restenosis. Coronary Computed Tomography Angiography (CCTA) with or without Computed Tomography Perfusion (CTP) vs. Angiography was evaluated on Detection of in-stent restenosis (ISR) (DOR 45.7, 95% CI 22.71-82.43). CCTA demonstrated high diagnostic performance for detecting in-stent restenosis, yielding a per-stent sensitivity of 90% and a diagnostic odds ratio of 45.7 (95% CI 22.71-82.43).
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