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Angiographic patterns of in-stent restenosis classified by computed tomography in patients with drug-eluting stents: correlation with invasive coronary angiography

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Abstract

Objectives

To evaluate the diagnostic accuracy of Mehran’s in-stent restenosis (ISR) classification by coronary computed angiography (CCTA), with reference to invasive coronary angiography (ICA).

Methods

Consecutive symptomatic patients, who had clinically suspected ISR and implanted stent diameter ≥ 3 mm, were prospectively enrolled in our study. Mehran’s classification was employed by CCTA and ICA to classify ISR lesions into four subtypes: focal, diffuse intrastent, diffuse proliferative and total occlusion. CCTA and ICA measurement of lesion length was further compared.

Results

Sixty-one patients with 101 implanted stents were included in our study. The overall sensitivity, specificity, PPV and NPV of CCTA diagnosis of binary ISR, as shown by patient-based analysis (n = 61), were 100 % (49/49), 75 % (8/12), 92.45 % (49/53) and 100 % (8/8) respectively. Mehran’s classification of CCTA correlated well with ICA findings. The diagnostic accuracy of CCTA for class I, class II, class III and class IV lesions was 92.5 %, 91.67 %, 100 % and 100 % respectively. Lesion length was assessed to be significantly longer with CCTA than with ICA (11.03 ± 5.89 mm versus 8.56 ± 4.99 mm, P < 0.001).

Conclusions

Angiographic patterns of in-stent restenosis can be accurately classified by coronary computed angiography. The lesion length measured by CCTA is longer than that assessed by invasive coronary angiography

Key Points

• Patterns of in-stent restenosis can be accurately classified by coronary computed angiography.

• Lesion length appears longer on CCTA than on invasive coronary angiography.

• Stent occlusion is better delineated by coronary computed angiography.

• Optimal treatment can be planned pre-operatively based on CCTA evaluation.

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Abbreviations

CCTA:

coronary computed tomography angiography

CPR:

curved planar reformation

DES:

drug-eluting stent

ICA:

invasive coronary angiography

ISR:

in-stent restenosis

IVUS:

intravascular ultrasound

PCI:

percutaneous coronary intervention

QCA:

quantitative coronary angiography

TIMI:

thrombolysis in myocardial infarction

TLR:

target-lesion revascularisation

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Acknowledgements

This study is not supported by any grants. Dr. Zhigang Lu contributed significantly to the initial case collection, performing invasive coronary angiography and preparing the manuscript. Thus, all of the authors agree that he deserves to be the co-first author of this manuscript.

Conflicts of interest

There are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiology, Shanghai No. 6 People’s Hospital, School of Medicine, Shanghai Jiaotong University, No. 600, Yishan Road, Shanghai, China, 200233

    Jiayin Zhang & Minghua Li

  2. Department of Cardiology, Shanghai No. 6 People’s Hospital, School of Medicine, Shanghai Jiaotong University, No. 600, Yishan Road, Shanghai, China

    Jingwei Pan, Zhigang Lu & Meng Wei

Authors
  1. Jingwei Pan
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  2. Zhigang Lu
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  3. Jiayin Zhang
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  4. Minghua Li
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  5. Meng Wei
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Correspondence to Jiayin Zhang.

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Pan, J., Lu, Z., Zhang, J. et al. Angiographic patterns of in-stent restenosis classified by computed tomography in patients with drug-eluting stents: correlation with invasive coronary angiography. Eur Radiol 23, 101–107 (2013). https://doi.org/10.1007/s00330-012-2559-2

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  • DOI: https://doi.org/10.1007/s00330-012-2559-2

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