Multidector CT Imaging of Coronary Artery Stent and Coronary Artery Bypass Graft

Abstract

Additional information is available at the end of the chapter http://dx.doi.org/10.5772/54085 . IntroductionCoronary artery stenting has become the most important nonsurgical treatment for coronary artery disease. However, in-stent restenosis occurs at a relatively high rate and this problem has led to the routine use of invasive angiography for assessing stent patency. "lthough coronary angiography is the clinical gold standard and it is a very effective diagnostic tool for detecting such in-stent restenosis, it's clearly an invasive procedure with its associated morbidity and mortality risks. Therefore, a noninvasive technique for detecting in-stent restenosis would be of great interest and use for following up patients after coronary angioplasty. Multidetector-row CT MDCT is being increasingly used for noninvasive coronary artery imaging as it has high diagnostic accuracy for detecting coronary artery stenosis in native, non-stented, coronary arteries. The recently introduced -slice CT offers more improved spatial and temporal resolution than does and -slice CT and this results in superior visualization of the stent lumen and in-stent restenosis. However, although -slice MDCT allows for improved stent visualization, a relevant part up to % of the stent lumen is still not assessable Mahnken et al., . The metal of the stents can cause blooming artifacts that prevent the accurate interpretation of a lumen's patency. To improve a stent's visualization, numerous methods have been attempted such as dedicated post-processing or the use of dual-source CT. However, because of its presently limited sensitivity and high radiation exposure, MDCT should not be used as the first-line test to screen for in-stent restenosis in asymptomatic patients. Given its high specificity and negative predictive value, MDCT might be valuable for confirming stent occlusion in symptomatic patients.Coronary artery bypass graft C""G surgery is the standard care in the treatment of advanced coronary artery disease. Notwithstanding the clear benefits of bypass grafting, recurrent chest pain after myocardial revascularization surgery is a common postoperative © 2013 Song; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.presentation and the long-term clinical outcome after myocardial revascularization surgery is largely dependent on graft patency and the progression of coronary artery disease. Therefore, assessment of the status of the grafts and graft disease after C""G surgery is an important issue in cardiology. "lthough conventional coronary angiography is still standard method for assessment of the status of naïve and recipient vessels after C""G surgery, it is an invasive and costly procedure that is not risk-free. Recently, MDCT with retrospective electrocardiographic ECG gating has gained rapid acce...