Abstract
Following coronary angioplasty and stent implantation, restenosis remains common and its outcome difficult to predict. We set out to determine the diagnostic accuracy of electron-beam computed tomography (EBCT) for the non-invasive detection of stent obstruction. In a prospective, blinded investigation, we included 152 coronary artery segments in 117 patients treated with a stent implant. All segments were evaluated by a dynamic EBCT study that depicted contrast bolus passage distal to the stent and a CT angiographic study of the entire coronary arteries. It was found that delayed contrast enhancement in the distal segment correlated with angiographic stent obstruction (Spearman’s rank correlation, P=0.008), while all other indicators of stent occlusion did not correlate with angiographic diagnosis. However, direct comparison of patients with obstruction of less vs. more than 75% of luminal diameter did not yield any statistically significant differences of distal enhancement delay, and for the detection of >90% occlusion, the sensitivity was 72% at a specificity of 60%. Although delayed contrast enhancement distal to the stent upon EBCT did correlate with angiographical obstruction, the correlation did not suffice to appear clinically satisfactory.
Similar content being viewed by others
References
Achenbach S, Moshage W, Ropers D, Nossen J, Daniel WG (1998) Value of electron-beam computed tomography for the noninvasive detection of high-grade coronary-artery stenoses and occlusions. N Engl J Med 339:1964–1971
Erbel R, Haude M, Hopp HD et al (1998) Coronary artery stenting compared with balloon angioplasty for restenosis after initial balloon angioplasty. N Engl J Med 339:1672–1678
Ruygrok PN, Webster MWI, de Valk V et al (2002) Clinical and angiographic factors associated with asymptomatic restenosis after percutaneous coronary intervention. Circulation 104:2289–2294
Kastrati A, Mehilli J, Dirschinger J et al (2001) Restenosis after coronary placement of various stent types. Am J Cardiol 87:34–39
Pump H, Möhlenkamp S, Sehnert CA et al (2000) Coronary artery stent patency: assessment with electron-beam CT. Radiology 214:447–452
Lu B, Dai R et al (2000) Detection and analysis of intracoronary artery stent after PTCA using contrast-enhanced three-dimensional electron-beam tomography. J Invasive Cardiol 12:1–6
Möhlenkamp S, Pump H et al (1999) Minimally invasive evaluation of coronary stents with electron-beam computed tomography: in vivo and in vitro experience. Catheter Cardiovasc Interv 48:39–47
TIMI Study Group (1985) The thrombolysis in myocardial infarction (TIMI) trial. Phase I findings. N Engl J Med 312:932–936
Nieman K, Cademartiri F, Lemos PA, Raaijmakers R, Pattynama PMT, de Feyter PJ (2002) Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography. Circulation 106:2051–2054
Achenbach S, Ropers D, Holle J, Muschiol G, Daniel WG, Moshage W (2000) In-plane coronary motion velocity: measurement with electron-beam CT. Radiology 216:457–463
Lu B, Zhuang N, Mao S-S et al (2002) EKG-triggered CT data acquisition to reduce variability in coronary arterial calcium score. Radiology 224:838–844
Bateman TM, Gray RJ, Whiting JS et al (1986) Cine computed tomographic evaluation of aortocoronary bypass graft patency. J Am Coll Cardiol 8:693–698
Bateman TM, Gray RJ, Whiting JS et al (1987) Prospective evaluation of ultrafast cardiac computed tomography for determination of coronary bypass graft patency. Circulation 75:1018–1024
Stanford W, Brundage BH, MacMillan R et al (1988) Sensitivity and specificity of assessing coronary artery bypass patency with ultrafast computed tomography: results of a multicenter study. J Am Coll Cardiol 12:1–7
Weiss RM, Grover-McKay (1994) Assessment of coronary artery patency with cine computed tomography in a dog model of occlusion-reperfusion. Invest Radiol 29:168–171
Achenbach S, Moshage W, Ropers D, Nossen J, Bachmann K (1997) Noninvasive, three-dimensional visualization of coronary artery bypass grafts by electron beam tomography. Am J Cardiol 79:856–861
Pump H, Moehlenkamp S, Sehnert C et al (1998) Electron-beam CT in the noninvasive assessment of coronary stent patency. Acad Radiol 5:858–862
Schmermund A, Haude M, Baumgart D et al (1996) Non-invasive assessment of coronary palmaz-schatz stents by contrast enhanced electron beam computed tomography. Eur Heart J 17:1546–1553
Elezi S, Kastrati A, Neumann FJ, Hadamitzky M, Dirschinger J, Schömig A (1998) Vessel size and long-term outcome after coronary stent placement. Circulation 98:1875–1880
Sinitsyn V, Belkind M et al (2003) Relationships between coronary calcification detected at electron beam computed tomography and percutaneous transluminal coronary angioplasty results in coronary artery disease patients. Eur Radiol 13:62–67
American College of Cardiology/American Heart Association Task Force on Practice Guidelines (1999) ACC/AHA guidelines for coronary angiography. J Am Coll Cardiol 33:1756–1824
Nikolaou K, Huber A et al (2002) Intraindividual comparison of contrast-enhanced electron-beam computed tomography and navigator-echo-based magnetic resonance imaging for noninvasive coronary artery angiography. Eur Radiol 12:1663–1671
Krüger S, Mahnken AH et al (2003) Nultislice spiral computed tomography for the detection of coronary stent restenosis and patency. Int J Cardiol 89:167–172
Maintz D, Juergens KU et al (2003) Imaging of coronary artery stents using multislice computed tomography: an in vitro evaluation. Eur Radiol 13:830–835
Nieman K, Cademartiri F, Raaijmakers R, Pattynama P, de Feyter P (2003) Noninvasive angiographic evaluation of coronary stents with multi-slice spiral computed tomography. Herz 28:136–142
Knollmann F, Pfoh A (2003) Coronary artery imaging with flat-panel computed tomography. Circulation 107:1209
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Knollmann, F.D., Möller, J., Gebert, A. et al. Assessment of coronary artery stent patency by electron-beam CT. Eur Radiol 14, 1341–1347 (2004). https://doi.org/10.1007/s00330-004-2337-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-004-2337-x