Neointimal Hyperplasia in Carotid Stent Detected With Multislice Computed Tomography

Erasmus MC, Rotterdam, South Holland, Netherlands
Circulation (Impact Factor: 14.43). 12/2003; 108(21):e147. DOI: 10.1161/01.CIR.0000103947.77551.9F
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Available from: Filippo Cademartiri, Aug 29, 2015
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    ABSTRACT: PURPOSE: To evaluate the diagnostic accuracy of multislice computed tomography coronary angiography (MSCT-CA) in the detection of in-stent restenosis. MATERIALS AND METHODS: Forty-two patients (33 male, 9 female, mean age 58+/-8 years) previously subjected to percutaneous implantation of coronary stent with suspected in-stent restenosis, underwent a 16-row MSCT (Sensation 16, Siemens) examination. The average time between stent implantation and MSCT-CA was 7.4+/-5.3 months. The following scan parameters were used: collimation 16x0.75 mm, rotation time 0.42 s, feed 3.0 mm/rot., kV 120, mAs 500. After administration of iodinated contrast material (Iomeprol 400 mgI/ml, 100 ml at 4 ml/s) and bolus chaser (40 ml of saline at 4 ml/s) the scan was completed in <20 s. All segments with a stent were assessed by two observers in consensus and were graded according to the following scheme: patent stent, in-stent intimal hyperplasia (IIH) (lumen reduction <50%), in-stent restenosis (ISR) (=/>50%), in-stent occlusion (ISO) (100%). Consensus reading was compared with coronary angiography. RESULTS: Forty-seven stents were assessed (16 in the right coronary artery; 4 in the left main; 22 in the left anterior descending; 5 in the circumflex). In 7 (17%) stents there was ISR (3) or ISO (4), and in 4 (10%) stents there was IIH. The sensitivity and negative predictive values for the detection of ISO were 80% and 98%, respectively, while for the detection of ISR+ISO they were 50% and 89%, respectively. CONCLUSIONS: Although the results are encouraging, the follow-up of stent patency with MSCT-CA does not show a diagnostic accuracy suitable for clinical implementation.
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    ABSTRACT: We investigated the ability of 16-slice computer tomography (CT) to discriminate any restenosis after left main coronary artery stenting in 29 consecutive patients. CT was able to detect all stents and analyze the lumen properly in 27 of 29 cases. With the exception of arrhythmic or heavily calcified segments, multislice CT provides a noninvasive alternative to conventional coronary angiography in the follow-up of left main angioplasty with stenting.
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    ABSTRACT: To compare the effect of different reconstruction kernels and a noise-reducing postprocessing filter on the delineation of coronary artery stents in 16-slice CT-angiography. Ten patients with coronary stents (seven LAD, five RCX and three RCA) were examined with a 16-slice MDCT using standard acquisition parameters. Images were reconstructed using a medium soft (B30f) and a dedicated, edge-enhancing kernel (B46f). Additional postprocessing with an edge-preserving filter was performed on B46f images to reduce the image noise. In multiplanar reformations (MPRs) along and perpendicular to the stent axis, intraluminal attenuation values and the visible lumen diameter were measured. Image noise was measured in the subcutaneous fat using a region of interest (ROI) technique. Arterial enhancement in the aorta was 275.1 HU. Attenuation in the stent lumen was 390.4, 340.0 and 346.8 HU in MPRs derived from B30f, original B46 and postprocessed B46f images. The mean noise level was 20.4, 35.0 and 24.9 HU respectively. The visible lumen diameter was significantly greater in B46f and postprocessed B46f images (2.17 and 2.16 mm), compared to 1.93 mm in B30f images (p<0.01). Edge-enhancing reconstruction kernels increase the visible stent lumen, but also increase image noise. Dedicated postprocessing filters can reduce the introduced noise without a loss of spatial resolution.
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