Coronary Arterial Stent Patency: Assessment with Electron-Beam CT

Pump, Heiko; Möhlenkamp, Stefan; Sehnert, Cornelia; Schimpf, S.; Schmidt, A; Erbel, Raimund; Grönemeyer, Dietrich; Seibel, Rainer

doi:10.1148/radiology.214.2.r00fe44447

Cited by 63 publications

(31 citation statements)

References 24 publications

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“…3 EBCT also has limitations in spatial resolution and it is not suitable for the assessment of stent patency. 9 With the development of MSCT, however, it has become possible to visualize the precise anatomy of the moving heart. [10][11][12] Moreover, the recently introduced 16-slice MSCT system, which allows simultaneous acquisition of 16 submillimeter slices, enables more detailed imaging, not only of stenosed coronary arteries but also of stents implanted within coronary arteries.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of 16-Slice Multislice Spiral Computed Tomography for Follow-up Study of Coronary Stent Implantation

Watanabe

Uemura

Iwama

et al. 2006

Circ J

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n recent years, coronary stent implantation has become an established method for treating patients with coronary artery disease. However, in-stent restenosis attributable to intimal hyperplasia still occurs at a relatively high rate, not only with bare metal stents but also with drug eluting stents. 1,2 Conventional coronary angiography is still the domain of the assessment of 'in-stent' restenosis. However, angiography has limitations because of its invasiveness and high medical expense. Thus, a non-invasive alternative to assess the patency of the stented arterial segment would be highly desirable.The application of multislice spiral computed tomography (MSCT) for imaging the coronary vasculature has been continuously evolving. With increasing numbers of detector rows (currently as many as 64), computed tomography (CT) scanners now provide coronary arterial images with markedly improved temporal and spatial resolution. In vitro and phantom studies on stent imaging have shown that 16-slice MSCT can adequately resolve even the lumens of stents placed within small vessels. 3 In clinical settings, however, many factors, including motion artifacts because of arrhythmia or high heart rate, coronary calcification, and Circulation Journal Vol.70, June 2006artifacts as a result of metallic material, can impair the quality of images of implanted stents. The purpose of the present study, therefore, was to determine: (i) the usefulness of 16-slice MSCT for evaluating coronary stent patency in a clinical population; and (ii) the parameters that determine the quality of stent images. Methods Patients and Study ProtocolThe study consisted of 31 patients (27 male, 4 female; average age 64±10 years; 26 patients with old myocardial infarction, 5 with stable angina) who had been treated with coronary artery stent implantation (42 total stents) between November 2002 and August 2004. The patients were scheduled for follow-up invasive coronary angiography between June 2003 and November 2004. Before their angiography, each patient underwent MSCT to assess coronary stent patency. All patients were in sinus rhythm at the time of the CT angiography, and there were no contraindications to CT imaging. Twenty-five patients had a prescan heart rate of >70 beats/min; they were given a single oral dose of 20-40 mg metoprolol 90-120 min before the CT examination. This protocol was approved by our Institutional Ethics Committee (#2002-009, Nara Medical University Ethics Committee), and written informed consent was obtained from all patients. Background Although multislice spiral computed tomography (MSCT) is a promising technique for noninvasive coronary angiography, its usefulness in patients with stent implantation remains unclear. The aim of the present study was to compare the usefulness of MSCT with that of invasive coronary angiography for evaluating coronary stent patency. Methods and ResultsThirty-one patients were enrolled after coronary stent implantation. Sixteen-slice MSCT scans were performed (39.0±21.8 days) before follow-up coro...

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Section: Discussionmentioning

confidence: 99%

Usefulness of 16-Slice Multislice Spiral Computed Tomography for Follow-up Study of Coronary Stent Implantation

Watanabe

Uemura

Iwama

et al. 2006

Circ J

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“…Thus, in-stent restenosis could not be reliably detected in most cases. [201][202][203][204][205][206] The ability to visualize in-stent restenosis depends on stent design and material, stent size, and scanner technology. [207][208][209] Thus, further studies may prove that a certain combination of stent type and scanner technology may permit the detection of in-stent restenosis.…”

Section: Follow-up Of Percutaneous Coronary Interventionmentioning

confidence: 99%

Assessment of Coronary Artery Disease by Cardiac Computed Tomography

Budoff¹,

Achenbach²,

Blumenthal³

et al. 2006

Circulation

1,246

382

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“…Electron beam tomography, magnetic resonance (MR) angiography, and MSCT have been evaluated for the assessment of coronary artery stents. Electron beam tomography does not permit direct visualization of the stent lumen [8, 9]. In MR imaging, currently employed stainless steel stents cause susceptibility artifacts, resulting in signal loss [10].…”

Section: Discussionmentioning

confidence: 99%

In vitro Evaluation of Metallic Coronary Artery Stents with Sub-Millimeter Multi-Slice Computed Tomography Using an ECG-Gated Cardiac Phantom: Relationship between In-Stent Visualization and Stent Type

Utsunomiya

Awai²,

Sakamoto

et al. 2006

Cardiology

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The aim of this experimental study was to investigate visualization of various coronary artery stents with sub-millimeter multi-slice spiral computed tomography (MSCT) using a cardiac physical phantom. Four 3-mm stents of various designs were implanted in tubes with an inner diameter of 3 mm to simulate coronary artery. Stents were placed on a cardiac phantom and scanned at different heart rates. Retrospective ECG-gated adaptive segmental reconstruction technique was employed. Profile curves across longitudinal curved planar reconstruction images of the stents were generated. From the profile curve, the full width at half maximum was defined as the stent lumen index. The effect of heart rate and stent type on the stent lumen index was evaluated. Visual evaluation for each stent at various heart rates was also performed. The heart rate had no significant effect on in-stent visualization. However, in-stent visualization differed significantly for the various stent types for both profile curve analysis and visual evaluation (the Tukey-Kramer multiple comparisons test). Multiple regression analysis indicated that strut thickness, especially minimal strut thickness, was the significant influencing factor for the in-stent visualization. On the basis of four stent models examined it would appear that visualization of the coronary stent lumen varies depending on the stent type, but not on the heart rate. Stents with slim struts are preferable for in-stent evaluation with multi-slice spiral computed tomography.

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Coronary Arterial Stent Patency: Assessment with Electron-Beam CT

Abstract: Electron-beam CT may be helpful in localizing intracoronary stents and assessing stent patency noninvasively to delay the intervals between catheterizations in an increasing number of patients.

Cited by 63 publications

References 24 publications

Usefulness of 16-Slice Multislice Spiral Computed Tomography for Follow-up Study of Coronary Stent Implantation

Usefulness of 16-Slice Multislice Spiral Computed Tomography for Follow-up Study of Coronary Stent Implantation

Assessment of Coronary Artery Disease by Cardiac Computed Tomography

In vitro Evaluation of Metallic Coronary Artery Stents with Sub-Millimeter Multi-Slice Computed Tomography Using an ECG-Gated Cardiac Phantom: Relationship between In-Stent Visualization and Stent Type

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