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In vitro evaluation of coronary stents and in-stent stenosis using a dynamic cardiac phantom and a 64-detector row CT scanner

Clinical Research in Cardiology volume 96, pages 883–890 (2007)Cite this article

Abstract

Introduction

The aim of the study was to examine the ability of a 64-slice MDCT to detect in-stent stenoses in an ex vivo model of coronary stents.

Methods

Five different stents (Liberté™, Boston Scientific; Driver®, Medtronic; Multi-Link Vision®, Guidant; Taxus® Express®, Boston Scientific; Cypher®, Cordis) were examined using a dynamic cardiac phantom. The stents were pulled over a vessel model that consists of a polymer tube with diameters of 3.0, 3.5, and 4.0 mm and four different degrees of stenoses (0%; 30%; 50%; 70–80%). This model was moved with a rate of 60 bpm to mimic cardiac motion. To assess the degree of artificial signal reduction (artificial reduction of attenuation (ARA)) by the different stents, attenuation values were measured in the vessel outside the stent, and in the non-stenotic vessel inside the stent. Furthermore the grade of stenosis was assessed by two clinical observers.

Results

Highest ARA was found for the Cypher® Stent (35 HU), whereas the Liberté™ Stent presented the lowest ARA (16 HU). Depending on the stent and the vessel diameter, up to 87.5% of the stenoses were correctly diagnosed. In the 3.0 and 3.5 mm vessels, a nonstenotic or low-grade stenotic vessel was diagnosed as intermediate or high-grade stenosis in 22.5%, whereas in the 4.0 mm vessels, this kind of overestimation did not occur. A 50% stenosis was diagnosed as a 30% stenosis in 30%. On the other hand, highgrade stenoses were underestimated in only 10%. On a fourpoint scale, the average deviation from the real grade of stenosis was 0.21 for the Liberté™ stent, 0.54 for the Taxus® Express® stent, 0.29 for Driver® stent, 0.62 for the Multi-Link Vision® stent, and 0.37 for the Cypher™ stent.

Conclusions

In a dynamic cardiac phantom model, high grade stenoses in vessels with a diameter of 4 mm could be reliably detected irrespective of the stent type used in this study. Vice versa, high grade stenoses (≥50%) could only be ruled out with certainty in vessels with a diameter of 4 mm. In smaller vessels, the ability to correctly diagnose high-grade stenoses was dependent on the type of stent and the imaging artifacts associated with it.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany

    Thomas Schlosser MD & Jörg Barkhausen MD

  2. Cardioangiologisches Centrum Bethanien, Frankfurt/Main, Germany

    Thomas Schlosser MD, Thomas Voigtländer MD & Axel Schmermund MD

  3. Boston Scientific, Technologie Zentrum GmbH, München, Germany

    Torsten Scheuermann PhD, Michael Kühling PhD & Peter E. Albrecht PhD

  4. Siemens AG Medical Solutions, Forchheim, Germany

    Stefan Ulzheimer PhD

  5. Department of cardiovascular Imaging at Alice-Hospital, Darmstadt, Germany

    Oliver K. Mohrs MD

Authors
  1. Thomas Schlosser MD
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  2. Torsten Scheuermann PhD
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  3. Stefan Ulzheimer PhD
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  4. Oliver K. Mohrs MD
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  5. Michael Kühling PhD
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  6. Peter E. Albrecht PhD
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  7. Thomas Voigtländer MD
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  8. Jörg Barkhausen MD
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  9. Axel Schmermund MD
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Correspondence to Thomas Schlosser MD.

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Schlosser, T., Scheuermann, T., Ulzheimer, S. et al. In vitro evaluation of coronary stents and in-stent stenosis using a dynamic cardiac phantom and a 64-detector row CT scanner. Clin Res Cardiol 96, 883–890 (2007). https://doi.org/10.1007/s00392-007-0564-2

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  • DOI: https://doi.org/10.1007/s00392-007-0564-2

Key words

  • multislice computed tomography (MSCT)
  • multi-detector computed tomography (MDCT)
  • cardiac
  • coronary stents
  • in-stent stenosis