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Assessment of coronary in-stent restenosis: value of subtraction coronary computed tomography angiography

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Abstract

In conventional coronary computed tomography angiography (CCTA), metal artifacts are frequently observed where stents are located, making it difficult to evaluate in-stent restenosis. This study was conducted to investigate whether subtraction CCTA can improve diagnostic accuracy in the evaluation of in-stent restenosis. Subtraction CCTA was performed using 320-row CT in 398 patients with previously placed stents who were able to hold their breath for 25 s and in whom mid-diastolic prospective one-beat scanning was possible. Among these patients, 126 patients (94 men and 32 women, age 74 ± 8 years) with 370 stents who also underwent invasive coronary angiography (ICA) were selected as the subjects of this study. With ICA findings considered the gold standard, conventional CCTA was compared against subtraction CCTA to determine whether subtraction can improve diagnostic accuracy in the evaluation of in-stent restenosis. When non-assessable stents were considered to be stenotic, the diagnostic accuracy in the evaluation of in-stent restenosis was 62.7 % for conventional CCTA and 89.5 % for subtraction CCTA. When the non-assessable stents were considered to be non-stenotic the diagnostic accuracy was 90.3 % for conventional CCTA and 94.31 % for subtraction CCTA. When subtraction CCTA was used to evaluate only the 138 stents that were judged to be non-assessable by conventional CCTA, 116 of these stents were judged to be assessable, and the findings for 109 of them agreed with those obtained by ICA. Even for stents with an internal diameter of 2.5–3 mm, the lumen can be evaluated in more than 80 % of patients. Subtraction CCTA provides significantly higher diagnostic accuracy than conventional CCTA in the evaluation of in-stent restenosis.

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Author information

Authors and Affiliations

  1. Department of Radiology, Takase Clinic, 885-2 Minami-Orui, Takasaki, Gunma, 370-0036, Japan

    Makoto Amanuma

  2. Department of Cardiology, Jukokai Central Hospital, Miyoshi, Japan

    Taskeshi Kondo

  3. Department of Radiation Technology, Takase Clinic, Takasaki, Japan

    Tomonari Sano, Tomoya Takayanagi, Hideyuki Matsutani, Takako Sekine, Takehiro Arai, Hitomi Morita & Kazumasa Ishizaka

  4. Clinical Application Research Center, Toshiba Medical Corporation, Ōtawara, Japan

    Kazumasa Arakita

  5. Application Group of CT Sales Department, Toshiba Medical Corporation, Ōtawara, Japan

    Akiko Iwasa

  6. Department of Cardiology, Takase Clinic, Takasaki, Japan

    Shinichi Takase

Authors
  1. Makoto Amanuma
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  2. Taskeshi Kondo
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  3. Tomonari Sano
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  4. Tomoya Takayanagi
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  5. Hideyuki Matsutani
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  6. Takako Sekine
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  7. Takehiro Arai
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  8. Hitomi Morita
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  9. Kazumasa Ishizaka
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  10. Kazumasa Arakita
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  11. Akiko Iwasa
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  12. Shinichi Takase
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Corresponding author

Correspondence to Makoto Amanuma.

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Conflict of interest

Dr. M Amanuma, RTs T Sano, T Takayanagi, T Arai, and Dr. S Takase have a contract of research cooperation with The Toshiba Medical Systems Corporation. This investigation was not funded. Drs. K Arakita and A Iwasa are employees of Toshiba Medical Systems Corporation. The other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all individual participants included in the study.

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Amanuma, M., Kondo, T., Sano, T. et al. Assessment of coronary in-stent restenosis: value of subtraction coronary computed tomography angiography. Int J Cardiovasc Imaging 32, 661–670 (2016). https://doi.org/10.1007/s10554-015-0826-4

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  • DOI: https://doi.org/10.1007/s10554-015-0826-4

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