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

Watanabe, Makoto; Uemura, Shiro; Iwama, Hajime; Okayama, Satoshi; Takeda, Yukiji; Kawata, Hiroyuki; Horii, Manabu; Nakajima, Takahito; Hirohashi, Shinji; Kichikawa, Kimihiko; Ookura, Akira; Saito, Yoshihiko

doi:10.1253/circj.70.691

Cited by 15 publications

(9 citation statements)

References 20 publications

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“…The 16-slice CT scanners are more successful than 4-slice CT scanners in evaluation of intracoronary stents with high imaging quality due to thinner slices, high gantry rotation speed and short breath-hold period. The sensitivity and specificity of 16-slice CT scanners in detection of intracoronary stent restenosis ranged between 57-83% and 88-99%, respectively and the average rate of assessed stents was 86% (Schuijf et al, 2004;Gilardi et al, 2006;Kitagawa et al, 2006, Watanabe et al, 2006Kefer et al, 2007;Soon et al, 2007). In our study, the sensitivity of 33% is quite low compared to other studies, but the specificity is compatible with other studies.…”

Section: Discussionsupporting

confidence: 85%

Clinical usefulness of the 16-slice computed tomography coronary angiography for evaluation of early phase intracoronary stent patency

Yüksel¹,

Şahin²,

Elmalı³

et al. 2013

jecm

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Article HistoryReceived 02 / 08 / 2012 Accepted 30 / 08 / 2012Coronary artery stenting is currently treatment of choice for management of coronary artery disease. Stent restenosis is the most important problem during follow up. Conventional coronary angiography is the gold standart for assessment of intracoronary stent patency. It is an invasive method and even though rare, has some significant risks. For this reason, noninvasive imaging methods are necessary to evaluate stent patency. Noninvasive methods such as the exercise test, myocardial perfusion scintigraphy and stress echocardiography could not reach enough diagnostic accuracy. Multislice computed tomography (MSCT) has been under investigation for stent restenosis detection. Aim of this study is to investigate usefulness of the 16-slice CT for evaluation of stent patency in patients with suspicion of stent restenosis. Thirty six patients were included in the study and 16-slice CT and conventional coronary angiographies were performed in all patients. The results of 16-slice CT and conventional coronary angiography were compared. Sufficient or good quality imaging with 16-slice CT angiography was obtained in 69% of all patients. Sixteen-slice CT angiography detected 42/49 (86%) stents and gave the correct localization for all of the detected stents. Stent lumen could be assessed in 30 (61%) stents and according to the results of luminal assessment, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of 16-slice MSCT were calculated as 33%, 95%, 75%, 77% and 77%, respectively. According to these results, the diagnostic performance of 16-slice CT angiography for detection of stent restenosis was relatively low. However, the assessment of relatively small number of stents because of insufficient heart rate control did not allow reliable and precise evaluation. Our results showed that diagnostic capacity of 16-slice CT angiography for detection of coronary stent restenosis is limited.

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Section: Discussionsupporting

confidence: 85%

Clinical usefulness of the 16-slice computed tomography coronary angiography for evaluation of early phase intracoronary stent patency

Yüksel¹,

Şahin²,

Elmalı³

et al. 2013

jecm

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“…It has been suggested that MSCT could reduce the need for invasive diagnostic procedures by non-invasively excluding in-stent restenosis [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. The present meta-analysis identifies that this optimistic view could be envisioned only in highly selected patients and mainly in patients with proximal and large stents, as frequently commented on in the individual studies [22,23].…”

Section: Discussionmentioning

confidence: 56%

“…The present meta-analysis identifies that this optimistic view could be envisioned only in highly selected patients and mainly in patients with proximal and large stents, as frequently commented on in the individual studies [22,23]. Indeed small stent diameter has been identified by several groups as a major factor for failure of in-stent restenosis assessment, with a consensus that only stents with diameter >3 mm are routinely interpretable [6,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. However, in routine clinical settings, many patients are treated with relatively small stents, having diameters of 2.5 mm or 3.0 mm.…”

Section: Discussionmentioning

confidence: 92%

“…After title/abstract assessment, we retrieved 35 studies as complete reports, from which 20 were excluded because (1) they did not employ MSCT or ≥16 slices MSCT; (2) they looked only at grafts or at atherosclerotic plaque assessment; (3) they had overlapping data; (4) they were in a language other than English; (5) it was impossible to find or calculate absolute figures from presented data; overlapping or duplicated publication was obvious; or (6) no systematic angiographic control was performed. Thus, we included 15 of these studies in the systematic review [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. All studies were published between January 2004 and February 2007, or were in press, or ahead of publication and then available on a dedicated journal website in February 2007.…”

Section: Resultsmentioning

confidence: 99%

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Diagnostic accuracy of in-stent coronary restenosis detection with multislice spiral computed tomography: a meta-analysis

et al. 2007

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This study was designed to define the current role of multislice spiral computed tomography (MSCT) for the diagnosis of coronary in-stent restenosis using a meta-analytic process. Restenosis remains a limitation after coronary stent implantation and contributes to a substantial number of coronary re-assessments by conventional invasive coronary angiography (CA). We identified 15 studies (807 patients) evaluating in-stent restenosis by means of both MSCT (>or=16 slices) and conventional CA until February 2007. After data extraction the analysis was performed according to a random-effects model. The analysis pooled the results from 15 studies with a total of 1,175 stents. A substantial number of unassessable stents (13%) were excluded from the analysis underscoring the shortcomings of MSCT. With this major limitation the diagnostic performance of MSCT for in-stent restenosis detection can be summarized as follows: the sensitivity and specificity were 84% [95% confidence interval (CI) 77-89%] and 91% (95% CI 89-93%), respectively, with positive and negative likelihood ratios of 12.2 (95% CI 6.6-22.6) and 0.23 (95% CI 0.17-0.31), respectively, and with a diagnostic odds ratio of 67.9 (95% CI 34.4-134.1). MSCT has shortcomings difficult to overcome in daily practice for in-stent restenosis detection and continues to have moderately high sensitivity and specificity. The diagnostic role of this emerging technology as an alternative to CA for in-stent restenosis detection remains limited.

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“…5). Newer scanners with progressively greater fields of view have now been applied in patients with various types of stents [74,75,76,77,78,79,80,81,82,83]. For example, using a 40-slice scanner, our group has shown that the extent of luminal stent diameter obscured due to the blooming artifact averages about one third of the luminal diameter of the stent [84].…”

Section: Assessment After Revascularizationmentioning

confidence: 99%

Current Status and Clinical Applications of Cardiac Multidetector Computed Tomography

Halon

Rubinshtein²,

Gaspar³

et al. 2007

Cardiology

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Contrast-enhanced multidetector-row computed tomography (MDCT) is now capable of providing high-quality noninvasive views of cardiac anatomy and ‘instant’ noninvasive coronary angiography. With current generation 64-slice scanners, MDCT can be performed in most patients with minimal patient discomfort and high diagnostic accuracy. MDCT may obviate the need for invasive diagnostic angiography in patients with borderline symptoms or equivocal noninvasive testing. It is useful in assessing the symptomatic patient postrevascularization and in emergency room triage in selected patients with chest pain. Calcified vessels are still difficult to assess, as is the accurate evaluation of implanted coronary stents. The volume of contrast material required for proper opacification limits the use of MDCT in patients with renal dysfunction, but newer emerging technologies will greatly improve these disadvantages in the near future. MDCT is expected to become an integral part of our diagnostic armamentarium in the cardiac patient.

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

Cited by 15 publications

References 20 publications

Clinical usefulness of the 16-slice computed tomography coronary angiography for evaluation of early phase intracoronary stent patency

Clinical usefulness of the 16-slice computed tomography coronary angiography for evaluation of early phase intracoronary stent patency

Diagnostic accuracy of in-stent coronary restenosis detection with multislice spiral computed tomography: a meta-analysis

Current Status and Clinical Applications of Cardiac Multidetector Computed Tomography

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