Reversible defects on myocardial perfusion imaging early after coronary stent implantation: A predictor of late restenosis
Department of Nuclear Medicine, Wonkwang University School of Medicine, 344-2 Shinyong-Dong, Iksan, Jeollabuk-do 570-711, Korea. The International Journal of Cardiovascular Imaging
(Impact Factor: 1.81).
07/2008; 24(5):503-10. DOI: 10.1007/s10554-007-9273-1
If coronary artery was treated with optimal stent implantation, myocardial perfusion in the territory supplied by a dilated coronary artery should be not reversible. However, several studies have demonstrated reversible perfusion in the territory supplied by a coronary artery with an optimally implanted stent. The main objective of this study was to evaluate the incidence of reversible defects detected by M-SPECT early after optimal PTCA with stent implantation. Its second objective was to determine the predictive value of detecting reversible defects after stent implantation for late restenosis.
About 66 patients that underwent M-SPECT within 24 h of successful PTCA with stent implantation were included. All patients were followed up clinically and angiographically. The incidence of reversible perfusion defects on M-SPECT and the rate of late restenosis in target coronary arteries were evaluated retrospectively.
Reversible perfusion defects on M-SPECT were observed in 26% of the patients and in 36% of lesions following successful PTCA with stent implantation. The incidence of late restenosis was significantly higher in patients and lesions with reversible perfusion defects (47% vs. 18%). According to binary logistic regression analysis, the presence of a reversible perfusion defects was the only independent predictor of late restenosis.
Available from: Ioannis Tsougos
- "In conclusion, authors suggested that endothelial dysfunction may be a possible cause of perfusion defect following PCI. The use of stents has lowered the rates of early post-PCI false positive MPI scans and therefore, in cases concerning the adequacy of high-risk angioplasty procedure, early stress MPI scans are considered clinically useful and safe nowadays . "
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ABSTRACT: Coronary artery disease (CAD) is the most prevalent form of cardiovascular disease affecting about 13 million Americans, while more than one million percutaneous transluminal intervention (PCI) procedures are performed annually in the USA. The relative high occurrence of restenosis, despite stent implementation, seems to be the primary limitation of PCI. Over the last decades, single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), has proven an invaluable tool for the diagnosis of CAD and patients’ risk stratification, providing useful information regarding the decision about revascularization and is well suited to assess patients after intervention. Information gained from post-intervention MPI is crucial to differentiate patients with angina from those with exo-cardiac chest pain syndromes, to assess peri-intervention myocardial damage, to predict-detect restenosis after PCI, to detect CAD progression in non-revascularized vessels, to evaluate the effects of intervention if required for occupational reasons and to evaluate patients’ long-term prognosis. On the other hand, chest pain and exercise electrocardiography are largely unhelpful in identifying patients at risk after PCI.
Although there are enough published data demonstrating the value of myocardial perfusion SPECT imaging in patients after PCI, there is still debate on whether or not these tests should be performed routinely.
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ABSTRACT: In this article, the role of nuclear cardiology modalities in the diagnosis and follow-up of ischemic coronary artery disease in respect of myocardial perfusion and determination of left ventricular ejection fraction are reviewed. Single photon emission tomography (SPET) and positron emission tomography (PET) techniques are applied for imaging of myocardial perfusion and evaluation of global and regional wall motion and contractility. These techniques could be applied with physiological or pharmacological stress and show different properties when compared to other imaging modalities mostly depending on anatomical details. Diagnostic value of myocardial perfusion scintigraphy and incremental value of SPET or PET/CT (computerized tomography) hybrid imaging is considered. Nuclear cardiology techniques may provide useful prognostic information besides their diagnostic use.
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ABSTRACT: Different angiographic patterns and restenosis rate may affect diagnostic value of single-photon emission computed tomography (SPECT) in the era of drug-eluting stents (DES). We aimed to determine the ability of myocardial SPECT to detect in-stent restenosis (ISR) in patients treated with DES compared to that of patients treated with bare metal stent (BMS). We evaluated 228 consecutive patients who underwent 6 months follow-up SPECT and coronary angiography (CAG) after stent implantation. In 228 patients, 354 vessels were treated with stent implantation (BMS, n = 105; DES, n = 249) and 65 (18.4%) vessels showed ISR (angiographic % diameter stenosis ≥50%) at the 6-month follow-up CAG. In patients with BMS-ISR (n = 37), restenosis was primarily diffuse (70.3%), whereas patients with DES-ISR (n = 28) exhibited more focal restenosis (53.6%, p = 0.028). The sensitivity and specificity of myocardial SPECT did not differ significantly between patients with BMS and those with DES (BMS vs. DES: sensitivity 56.8 vs. 39.3%, p = 0.163; specificity 72.1 vs. 76.5%, p = 0.460). Evaluation of 71 false positive and 33 false negative lesions showed that the most common cause of false-positive results in SPECT was the perfusion decrease which improved but not disappeared compared with the baseline (46 among 71 vascular territories). Despite different patterns of restenosis and ISR rates, the diagnostic value of SPECT did not differ between BMS and DES. Further study looking at ISR in larger number of patients and using other protocol such as Fleming-Harrington Redistribution Wash-in Washout may give additional information.
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