ROLE OF 128-SLICE, DUAL-SOURCE CT CORONARY ANGIOGRAPHY AS A NOVEL IMAGING TECHNIQUE IN ASSESSMENT OF IN-STENT RESTENOSIS

Document Type : Original Article

Authors

1 Department of Radiodiagnosis, Faculty of medicine, Ain Shams university, and Radiodiagnosis Specialist in Manshiet El Bakry – General Hospital Cairo , Egypt.

2 Department of radiodiagnosis, Faculty of medicine, Ain Shams university, and Radiodiagnosis Specialist in Manshiet El Bakry – General Hospital Cairo , Egypt.

Abstract

Background: Over the past 35 years, catheter-based intervention has become the dominant form of coronary revascularization. Percutaneous coronary interventions are increasingly performed. The most important advance in the field of percutaneous coronary interventions was the introduction of coronary stent implantation in the 1990s, which led to reductions in incidence of restenosis. The use of multi–slice CT is gaining increasing acceptance for noninvasive cardiac imaging. Recent years with the new emerging machines have demonstrated successful application of multi–slice CT angiography for the noninvasive assessment of coronary artery disease and the evaluation of coronary artery stents.
Aim of the Work: To evaluate the role of 128-slice, dual-source CT coronary angiography as a novel technique in assessment of coronary artery in-stent restenosis. Patients and Methods: This study included forty patients with
prior coronary artery stent implantation. The mean age of the included patients was 58 with an age range between 40 and 73 years. A total of 42 coronary artery stents deployed within 40 patients were included in this study; and assessed by MSCT angiography and they underwent invasive coronary angiography as a gold standard for evaluation of the coronary artery stents. Results: In an overall view, MSCT angiography compared to the invasive coronary angiography as a gold standard technique gave us a sensitivity of 100%, a specificity of about 83.8 %, an accuracy of about 87.1%, positive predective value (PPV) is 61.5% and negative predective value (NPV) is 100% in the assessment of the patency of
the coronary artery stents, taking into consideration proper standard CT angiography techniques in all cases.
Conclusion: Our study helps to identify factors that influence the assessability of coronary artery stents by 128-slice dual source CT scanner, namely, stent type and diameter. It shows that under certain conditions, the detection of in-stent restenosis might be possible with an accuracy that could permit clinical applications, but the nonassessable stents do not allow the use of MSCT coronary angiography in unselected patients with implanted stents in coronary arteries. So that MSCT angiography as a noninvasive technique can be used for assessment of in-stent restenosis but patients must be
carefully selected.

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