Manghat Nathan, Van Lingen Robin, Hewson Paul, Syed Farhan, Kakani Nirmal, Cox Ian, Roobottom Carl, Morgan-Hughes Gareth
Department of Clinical Radiology, Derriford Hospital, Plymouth, Devon, United Kingdom.
Am J Cardiol. 2008 Jun 1;101(11):1567-73. doi: 10.1016/j.amjcard.2008.01.042. Epub 2008 Apr 2.
To determine whether 64-slice multidetector computed tomographic coronary angiography (MDCTA) can accurately assess the coronary artery lumen in symptomatic patients with previous coronary artery stents and potential in-stent restenosis (ISR). The primary aim was to determine the accuracy of binary ISR exclusion using MDCTA compared with invasive catheter angiography (ICA). Secondary aims were comparisons of stent dimensions measured using MDCTA and variables that affect accuracy. Forty patients with previous stent placement underwent both ICA and 64-slice MDCTA after elective presentation with chest pain, and ICA quantitative coronary angiographic data were used as the reference standard. Thirty-six men and 4 women (age 64 +/- 10 years; range 44 to 83) with 103 stents (2.8 +/- 1.6 stents/patient) were comparatively evaluated (stent exclusion rate 9.6%). There were 45 bare-metal and 58 drug-eluting stents (20 +/- 18 months after implantation) with an average diameter of 3.23 +/- 0.7 mm. Overall accuracy for the detection of significant ISR showed sensitivity, specificity, and positive and negative predictive values of 85%, 86%, 61%, and 96% for proximal stents > or =3 mm, which improved to 100%, 94%, 81%, and 100%; if the visible luminal diameter on MDCTA was <1.5 mm, accuracy decreased to 40%, 84%, 29%, and 90%, respectively. In conclusion, 64-slice MDCTA assessment of symptomatic patients with suspected clinically significant ISR is a realistic alternative to ICA if reference stent diameter is > or =2.5 mm and visible lumen cross-sectional diameter is > or =1.5 mm, for which a negative MDCTA result virtually excludes the presence of significant ISR.
为确定64层螺旋计算机断层扫描冠状动脉造影（MDCTA）能否准确评估有症状的既往冠状动脉支架置入患者的冠状动脉管腔及支架内再狭窄（ISR）的可能性。主要目的是确定使用MDCTA排除二元ISR的准确性，并与有创导管血管造影（ICA）进行比较。次要目的是比较使用MDCTA测量的支架尺寸以及影响准确性的变量。40例既往有支架置入史的患者在因胸痛择期就诊后接受了ICA和64层MDCTA检查，并将ICA定量冠状动脉造影数据用作参考标准。对36名男性和4名女性（年龄64±10岁；范围44至83岁）的103个支架（每位患者2.8±1.6个支架）进行了比较评估（支架排除率9.6%）。有45个裸金属支架和58个药物洗脱支架（植入后20±18个月），平均直径为3.23±0.7mm。对于近端支架≥3mm，检测显著ISR的总体准确性显示敏感性、特异性、阳性和阴性预测值分别为85%、86%、61%和96%，若MDCTA上可见管腔直径<1.5mm，准确性分别降至40%、84%、29%和90%。总之，如果参考支架直径≥2.5mm且可见管腔横截面直径≥1.5mm，对于有可疑临床显著ISR的有症状患者，64层MDCTA评估是ICA的一种切实可行的替代方法，MDCTA结果为阴性实际上可排除显著ISR的存在。
