Department of Radiology, Shanghai No. 6 People's Hospital, School of Medicine, Shanghai Jiaotong University, No. 600, Yishan Rd, 200233 Shanghai, China.
Int J Cardiovasc Imaging. 2012 Mar;28(3):651-8. doi: 10.1007/s10554-011-9842-1. Epub 2011 Apr 3.
The diagnostic performance of in-stent restenosis (ISR) by 64-slice multidetector CT coronary angiography (CTCA) has been reported to be influenced by multiple factors. We evaluated individual factors (stent diameter, material and strut thickness) and therefore determined the proper population for follow-up by using this modality. A total of 171 stents were evaluated in 83 consecutive patients with stents imaged with CTCA and conventional coronary angiography. The stent diameter ranged from 2.25 mm to 4.5 mm. 2 models of stainless steel (Taxus Liberte (Boston Scientific, US), 56 stents and Cypher Select (Cordis, US), 34 stents) and 2 models of cobalt alloy (Endeavor (Medtronic, US), 33 stents and Firebird2 (MicroPort, China), 48 stents) were included. By comparing to conventional coronary angiography, the image quality and diagnostic accuracy for ISR were evaluated. The image quality of Taxus, Endeavor and Firebird are markedly better than Cypher in large caliber group (≧3.0 mm) (P < 0.001). Except for Cypher, all other stents with diameter ≧3.0 mm showed excellent diagnostic accuracy (sensitivity 100%, specificity 94.4-96% whereas stents with diameter <3.0 mm had poor diagnostic accuracy (sensitivity 100%, specificity 33.3-70%). Cypher is the stent with thickest strut in our study, and showed reduced image quality and diagnostic accuracy in all stent size, due to large number of unassessable stents. Among 16 binary ISR, 12 lesions were correctly diagnosed by CTCA while the other 4 lesions were unassessable. The main reason for low specificity in small caliber group is the large number of unassessable stents. CTCA has high diagnostic accuracy to identify ISR in selected stents with a diameter of ≧3.0 mm.
64 层多排螺旋 CT 冠状动脉成像（CTCA）诊断支架内再狭窄（ISR）的性能受多种因素影响。我们评估了个体因素（支架直径、材料和支架厚度），因此确定了使用这种方式进行随访的合适人群。对 83 例连续接受 CTCA 和常规冠状动脉造影检查的支架患者的 171 个支架进行了评估。支架直径范围为 2.25 毫米至 4.5 毫米。包括 2 种不锈钢支架（波士顿科学公司的 Taxus Liberte，56 个支架和柯迪斯公司的 Cypher Select，34 个支架）和 2 种钴合金支架（美敦力公司的 Endeavor，33 个支架和微创公司的 Firebird2，48 个支架）。通过与常规冠状动脉造影比较，评估了 ISR 的图像质量和诊断准确性。在大口径组（≧3.0 毫米）中，Taxus、Endeavor 和 Firebird 的图像质量明显优于 Cypher（P<0.001）。除 Cypher 外，所有其他直径≧3.0 毫米的支架均具有出色的诊断准确性（敏感性 100%，特异性 94.4%-96%，而直径<3.0 毫米的支架诊断准确性较差（敏感性 100%，特异性 33.3%-70%）。在我们的研究中，Cypher 是支架厚度最厚的支架，由于无法评估的支架数量众多，所有支架尺寸的图像质量和诊断准确性均降低。在 16 个二元 ISR 中，12 个病变通过 CTCA 正确诊断，而另外 4 个病变无法评估。小口径组特异性低的主要原因是无法评估的支架数量众多。CTCA 对直径≧3.0 毫米的选定支架内再狭窄具有较高的诊断准确性。
