Francesca Pugliese MD, Presenter: Nothing to Disclose

Annick Carine Weustink MD, Abstract Co-Author: Nothing to Disclose

Filippo Alberghina MD, Abstract Co-Author: Nothing to Disclose

Nico R. Mollet MD, Abstract Co-Author: Nothing to Disclose

Masato Otsuka, Abstract Co-Author: Nothing to Disclose

Filippo Cademartiri MD, PhD, Abstract Co-Author: Nothing to Disclose

Pim J. De Feyter MD, PhD, Abstract Co-Author: Nothing to Disclose

M. G. Myriam Hunink MD, PhD, Abstract Co-Author: Grant, W. L. Gore & Associates, Inc

Gabriel P. Krestin MD, PhD, Abstract Co-Author: Consultant, General Electric Company

et al, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To prospectively evaluate the performance of Dual-source Computed Tomography Coronary Angiography (DSCT-CA) for the detection of in-stent restenosis (≥50% stenosis) in patients scheduled for conventional angiography (CA).

One hundred and thirty-three patients with previous percutaneous stent implantation and recurrent anginal symptoms were screened for inclusion in our study. Patients underwent DSCT-CA before CA.

Thirty-three patients were excluded because of serum creatinine level >120 µmol/l (n=4), known contrast allergy (n=3), irregular heart-rate (n=6) and refusal to undergo DSCT-CA (n=20). DSCT-CA was performed in 100 patients. Average heart-rate was 67±12 (range 46-106) beats per minute (bpm). There were 178 stented lesions. Restenosis was found in 39% (39/100) of patients and 22% (39/178) of stented lesions. Sensitivity, specificity, PPV and NPV of DSCT-CA, calculated on all stents, were 94%, 92%, 77% and 98%, respectively. Diagnostic performance in patients with heart-rates <70bpm (n=69) was similar to that obtained in patients with heart-rates ≥70bpm (n=31); diagnostic performance in single stents (n=95) was similar to that obtained in overlapping stents and bifurcations (n=83). For stents ≥3.5mm diameter (n=78), sensitivity, specificity, PPV, NPV were all 100%; for 3mm stents (n=59), sensitivity and NPV were 100%, specificity 97%, PPV 91%; for ≤2.75mm stents (n=41), sensitivity was 84%, specificity 64%, PPV 52%, NPV 90%. Specificity of DSCT-CA in stents ≥3.5mm was significantly higher than that obtained in stents ≤2.75mm (OR = 6.14; 99%CI: 1.52-9.79).

DSCT-CA induces false positives in stents ≤2.75mm; however, DSCT-CA has high NPV and reliably excludes in-stent restenosis.

Reliability of DSCT-CA in patients with stents may vary according to varying heart-rates, stent configurations and diameters. Knowledge of such limitations is mandatory for appropriate clinical use.

Pugliese, F, Weustink, A, Alberghina, F, Mollet, N, Otsuka, M, Cademartiri, F, De Feyter, P, Hunink, M, Krestin, G, et al, , et al, , Dual-source CT Angiography for Detecting In-Stent Restenosis in Coronary Arteries.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5010430.html