In vivo evaluation of stent patency by 64-slice multidetector CT coronary angiography: shall we do it or not?

  • Jiayin Zhang
  • Minghua Li
  • Zhigang Lu
  • Jingyu Hang
  • Jingwei Pan
  • Leiqing Sun
Original Paper


The diagnostic performance of in-stent restenosis (ISR) by 64-slice multidetector CT coronary angiography (CTCA) has been reported to be influenced by multiple factors. We evaluated individual factors (stent diameter, material and strut thickness) and therefore determined the proper population for follow-up by using this modality. A total of 171 stents were evaluated in 83 consecutive patients with stents imaged with CTCA and conventional coronary angiography. The stent diameter ranged from 2.25 mm to 4.5 mm. 2 models of stainless steel (Taxus Liberte (Boston Scientific, US), 56 stents and Cypher Select (Cordis, US), 34 stents) and 2 models of cobalt alloy (Endeavor (Medtronic, US), 33 stents and Firebird2 (MicroPort, China), 48 stents) were included. By comparing to conventional coronary angiography, the image quality and diagnostic accuracy for ISR were evaluated. The image quality of Taxus, Endeavor and Firebird are markedly better than Cypher in large caliber group (≧3.0 mm) (P < 0.001). Except for Cypher, all other stents with diameter ≧3.0 mm showed excellent diagnostic accuracy (sensitivity 100%, specificity 94.4–96% whereas stents with diameter <3.0 mm had poor diagnostic accuracy (sensitivity 100%, specificity 33.3–70%). Cypher is the stent with thickest strut in our study, and showed reduced image quality and diagnostic accuracy in all stent size, due to large number of unassessable stents. Among 16 binary ISR, 12 lesions were correctly diagnosed by CTCA while the other 4 lesions were unassessable. The main reason for low specificity in small caliber group is the large number of unassessable stents. CTCA has high diagnostic accuracy to identify ISR in selected stents with a diameter of ≧3.0 mm.


Computed tomography Coronary artery disease Angiography Stent 


  1. 1.
    Sousa JE, Serruys PW, Costa MA (2003) New frontiers in cardiology: drug-eluting stents: Part I. Circulation 107:2274–2279PubMedCrossRefGoogle Scholar
  2. 2.
    Sousa JE, Serruys PW, Costa MA (2003) New frontiers in cardiology: drug-eluting stents: Part II. Circulation 107:2283–2289Google Scholar
  3. 3.
    Moses JW, Leon MB, Popma JJ et al (2003) Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 349:1315–1323PubMedCrossRefGoogle Scholar
  4. 4.
    Stone GW, Ellis SG, Cox DA et al (2004) A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 350:221–231PubMedCrossRefGoogle Scholar
  5. 5.
    De Bono D, The Joint Audit Committee of the British Cardiac Society, Royal College of Physicians of London (1993) Complications of diagnostic cardiac catheterisation: results from 34,041 patients in the United Kingdom confidential enquiry into cardiac catheter complications. Br Heart J 70:297–300PubMedCrossRefGoogle Scholar
  6. 6.
    Young N, Chi KK, Ajaka J et al (2002) Complications with outpatient angiography and interventional procedures. Cardiovasc Intervent Radiol 25:123–126PubMedCrossRefGoogle Scholar
  7. 7.
    Stein PD, Yaekoub AY, Matta F et al (2008) 64-slice CT for diagnosis of coronary artery disease: a systematic review. Am J Med 121:715–725PubMedCrossRefGoogle Scholar
  8. 8.
    Daniel BM, Daniel SB, Matthew JB et al (2010) ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert consensus document on coronary computed tomographic angiography: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 121:2509–2543CrossRefGoogle Scholar
  9. 9.
    Ehara M, Surmely JF, Kawai M et al (2006) Diagnostic accuracy of 64-slice computed tomography for detecting angiographically significant coronary artery stenosis in an unselected consecutive patient population: comparison with conventional invasive angiography. Circ J 70:564–571PubMedCrossRefGoogle Scholar
  10. 10.
    Austen WG, Edwards JE, Frye RL et al (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 51:5–40PubMedGoogle Scholar
  11. 11.
    Tanabe K, Serruys PW, Grube E et al (2003) TAXUS III Trial: in-stent restenosis treated with stent-based delivery of paclitaxel incorporated in a slow-release polymer formulation. Circulation 107:559–564PubMedCrossRefGoogle Scholar
  12. 12.
    Fajadet J, Morice MC, Bode C et al (2005) Maintenance of long-term clinical benefit with sirolimus-eluting coronary stents: three-year results of the RAVEL trial. Circulation 111:1040–1044PubMedCrossRefGoogle Scholar
  13. 13.
    Ehara M, Kawai M, Surmely JF et al (2007) Diagnostic accuracy of coronary in-stent restenosis using 64-slice computed tomography: comparison with invasive coronary angiography. JACC 49:951–959PubMedGoogle Scholar
  14. 14.
    Rist C, von Ziegler F, Nikolaou K et al (2006) Assessment of coronary artery stent patency and restenosis using 64-slice computed tomography. Acad Radiol 13:1465–1473PubMedCrossRefGoogle Scholar
  15. 15.
    Rixe J, Achenbach S, Ropers D et al (2006) Assessment of coronary artery stent restenosis by 64-slice multi-detector computed tomography. Eur Heart J 27:2567–2572PubMedCrossRefGoogle Scholar
  16. 16.
    Cademartiri F, Schuijf JD, Pugliese F et al (2007) Usefulness of 64-slice multislice computed tomography coronary angiography to assess in-stent restenosis. J Am Coll Cardiol 49:2204–2210PubMedCrossRefGoogle Scholar
  17. 17.
    Oncel D, Oncel G, Karaca M (2007) Coronary stent patency and in-stent restenosis: determination with 64-section multidetector CT coronary angiography-initial experience. Radiology 242:403–408PubMedCrossRefGoogle Scholar
  18. 18.
    Gaspar T, Halon D, Lewis B et al (2005) Diagnosis of coronary in-stent restenosis with multidetector row spiral computed tomography. JACC 46:1573–1579PubMedGoogle Scholar
  19. 19.
    Maintz D, Seifarth H, Raupach R et al (2006) 64-slice multidetector coronary CT angiography: in vitro evaluation of 68 different stents. Eur Radiol 16:818–826PubMedCrossRefGoogle Scholar
  20. 20.
    Maintz D, Burg MC, Seifarth H et al (2009) Update on multidetector coronary CT angiography of coronary stents: in vitro evaluation of 29 different stent types with dual-source CT. Eur Radiol 19:42–49PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • Jiayin Zhang
    • 1
  • Minghua Li
    • 1
  • Zhigang Lu
    • 2
  • Jingyu Hang
    • 2
  • Jingwei Pan
    • 2
  • Leiqing Sun
    • 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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