European Radiology

, Volume 23, Issue 1, pp 101–107 | Cite as

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

  • Jingwei Pan
  • Zhigang Lu
  • Jiayin ZhangEmail author
  • Minghua Li
  • Meng Wei



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).


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.


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).


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.


Computed tomography Stent Restenosis Coronary angiography Coronary artery disease 



coronary computed tomography angiography


curved planar reformation


drug-eluting stent


invasive coronary angiography


in-stent restenosis


intravascular ultrasound


percutaneous coronary intervention


quantitative coronary angiography


thrombolysis in myocardial infarction


target-lesion revascularisation



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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Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Jingwei Pan
    • 2
  • Zhigang Lu
    • 2
  • Jiayin Zhang
    • 1
    Email author
  • Minghua Li
    • 1
  • Meng Wei
    • 2
  1. 1.Department of Radiology, Shanghai No. 6 People’s Hospital, School of MedicineShanghai Jiaotong UniversityShanghaiChina
  2. 2.Department of Cardiology, Shanghai No. 6 People’s Hospital, School of MedicineShanghai Jiaotong UniversityShanghaiChina

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