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Coronary stent occlusion: reverse attenuation gradient sign observed at computed tomography angiography improves diagnostic performance

  • Cardiac
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Abstract

Objectives

To evaluate the incidence and diagnostic performance of reverse attenuation gradient (RAG) sign in patients with coronary stent occlusion.

Methods

We retrospectively included patients with suspected restenosis who underwent both coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) within 2 weeks. Stent occlusion at CCTA was defined as (1) complete contrast filling defect of large calibre stents (at least 3 mm), or (2) presence of RAG sign in patients with small calibre stents (less than 3 mm) or (3) presence of RAG sign in patients with non-diagnostic image quality of stents. The diagnostic performance of RAG sign was further assessed by comparison to ICA results.

Results

A total of 162 patients with 231 implanted stents were included. ICA confirmed stent occlusion in 59 patients (99 stents). RAG sign was present in 59.3 % (35/59) of all stent occlusions. As shown by patient-based analysis, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of our diagnostic criteria for detection of stent occlusion were 79.7 % (47/59), 100 % (103/103), 100 % (47/47) and 89.6 % (103/115) respectively. Superior diagnostic performance was confirmed by receiver operating characteristic (ROC) analysis with an area under the curve of 0.898.

Conclusions

RAG sign observed at CCTA in patients with coronary stenting represents reverse collateral flow distal to stents and is highly specific to indicate stent occlusion.

Key Points

• RAG sign in patients with previous stents represents retrograde collateral flow.

• RAG sign in patients with previous stents indicates stent occlusion.

• RAG sign improves detection of stent occlusion in small calibre stents.

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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

TIMI:

Thrombolysis in myocardial infarction

TLR:

Target-lesion revascularization

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Acknowledgements

The scientific guarantor of this publication is Dr. Jiayin Zhang. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding by National Natural Science Foundation of China (Grant No.: 81301219) and Shanghai Committee of Science and Technology, China (Grant No.: 13ZR1431500). No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No.600, Yishan Rd, 200233, Shanghai, China

    Minghua Li & Jiayin Zhang

  2. Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No.600, Yishan Rd, 200233, Shanghai, China

    Qingyong Zhang, Jingwei Pan, Zhigang Lu & Meng Wei

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

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Li, M., Zhang, J., Zhang, Q. et al. Coronary stent occlusion: reverse attenuation gradient sign observed at computed tomography angiography improves diagnostic performance. Eur Radiol 25, 568–574 (2015). https://doi.org/10.1007/s00330-014-3429-x

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  • DOI: https://doi.org/10.1007/s00330-014-3429-x

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