Diagnostic accuracy of coronary in-stent restenosis using 64-slice computed tomography - Comparison with invasive coronary angiography

Objectives This study sought to evaluate the diagnostic accuracy of coronary binary in-stent restenosis (ISR) with angiography using 64-slice multislice computed tomography coronary angiography (CTCA) compared with invasive coronary angiography (ICA). Background A noninvasive detection of ISR would result in an easier and safer way to conduct patient follow-up. Methods We performed CTCA in 81 patients after stent implantation, and 125 stented lesions were scanned. Two sets of images were reconstructed with different types of convolution kernels. On CTCA, neointimal proliferation was visually evaluated according to luminal contrast attenuation inside the stent. Lesions were graded as follows: grade 1, none or slight neointimal proliferation; grade 2, neointimal proliferation with no significant stenosis (< 50%); grade 3, neointimal proliferation with moderate stenosis (>= 50%); and grade 4, neointimal proliferation with severe stenosis (>= 75%). Grades 3 and 4 were considered binary ISR. The diagnostic accuracy of CTCA compared with ICA was evaluated. Results By ICA, 24 ISRs were diagnosed. Sensitivity, specificity, positive predictive value, and negative predictive value were 92%, 81%, 54%, and 98% for the overall population, whereas values were 91%, 93%, 77%, and 98% when excluding unassessable segments (15 segments, 12%). For assessable segments, CTCA correctly diagnosed 20 of the 22 ISRs detected by ICA. Six lesions without ISR were overestimated as ISR by CTCA. As the grade of neointimal proliferation by CTCA increases, the median value of percent diameter stenosis increased linearly. Conclusions Binary ISR can be excluded with high probability by CTCA, with a moderate rate of false-positive results. (c) 2007 by the American College of Cardiology Foundation