Diagnostic value of intraluminal stent enhancement in estimating coronary in-stent restenosis

Abstract

Objective: In-stent restenosis (ISR) diagnosis is among the most serious complications of patients undergone stent implantation. Although coronary computed tomography angiography (CCTA) has been widely used for ISR assessing, stent narrow lumen and presence of stent’s struts artifacts have limited its efficacy. The use of quantitative techniques may provide more valuable findings for ISR diagnosis. The aim of this study is to assess the predictive value of a quantitative technique of ISR estimation based on stent intraluminal enhancement derived from CCTA. Materials and Methods: In the current study, 40 patients with the previous history of coronary artery diseases (CADs) and coronary stent placement who reexperienced CAD symptoms and referred for CCTA were assessed in 2017–2018. Stent intraluminal “enhancement value” (EV) was measured using calcium score and post-contrast images of CCTA. The cutoff point was determined using conventional invasive coronary angiography as the gold standard. Results: Total numbers of 58 stents were evaluated, in which stent intraluminal enhancement was assessed in initial, middle, and end sites of stent, achieved cutoff points for more than 50% of ISR were 204, 168, and 204 Hounsfield units, respectively. These cutoff points had diagnostic value of 77.5% for initial part, 86% for midpart, and 81% for end part, respectively. Conclusion: The use of quantitative method of stent intraluminal EV for ISR estimation has better diagnostic value in comparison to qualitative techniques that can help better clinical decision making. Moreover, measurements of this method are somewhat easier and also secondary artifacts of stent struts and calcified plaques would be eliminated.

P65/NLRP3 Inflammasome Mediated Endothelial Cells Pyroptosis: A Novel Mechanism of In-Stent Restenosis

“…However, in-stent restenosis (ISR) remains a significant challenge for patients undergoing PCI [3]. It was reported that there were about 10% of patients develop ISR [4,5]. In recent years, a number of in vitro and in vivo studies have identified some potential causes of ISR, including stent gap, residual uncovered atherosclerotic plaques and polymer damage.…”

Computer‐Aided Analysis of the Corrosion Inhibition by Carbon‐Based Thin‐Film Coating on Vascular Bare Metal Stent Models

“…[3] However, there are clinical limitations of stent placement such as corrosion processes and in-stent restenosis (ISR) formation. [4][5][6] Due to the risk of allergenic or cytotoxic species' release such as Ni, Co, Cr, or Al through the body, biomaterials have been developing considering their corrosion resistance. [7,8] DOI: 10.1002/adts.…”

“…[7,8] DOI: 10.1002/adts. 202100626 Blood tissue has an electrolytic feature because of the cation contents including H + , K + Na + , Ca 2+ , and Mg 2+ , and the anion contents including OH -, HCO 3 -, Cl -, PO 4 3-, and SO 4 2-. [9] Negatively and positively charged species in a flowing blood tissue cause implanted biomaterial and body fluid to have different electrical potentials.…”

The usefulness of subtraction coronary computed tomography angiography for in-stent restenosis assessment of patients with CoCr stent using 320-row area detector CT

“…If both have severe or tandem calcifications and stents, performance of coronary computed tomography angiography (CCTA) further reduced. [4][5][6] The gold standard for the evaluation of in-stent restenosis (ISR) in clinical is invasive coronary angiography (ICA). However, most of patients are willing to have non-invasively and efficiently assessment of ISR.…”

“…Normally, patients previously treated with stent often have high possibilities to show atherosclerotic burden of non-treated coronary segments. If both have severe or tandem calcifications and stents, performance of coronary computed tomography angiography (CCTA) further reduced [4–6] . The gold standard for the evaluation of in-stent restenosis (ISR) in clinical is invasive coronary angiography (ICA).…”