Published Online
on August 7, 2006

A more recent version of this article appeared on August 15, 2006

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Submitted on December 17, 2005
Revised on June 7, 2006
Accepted on June 8, 2006

Multislice Spiral Computed Tomography for the Evaluation of Stent Patency After Left Main Coronary Artery Stenting. A Comparison With Conventional Coronary Angiography and Intravascular Ultrasound

Carlos A.G. Van Mieghem MD, Filippo Cademartiri MD, PhD, Nico R. Mollet MD, PhD, Patrizia Malagutti MD, Marco Valgimigli MD, Willem B. Meijboom MD, Francesca Pugliese MD, Eugene P. McFadden MB, ChB, FRCPI, Jurgen Ligthart BSc, Giuseppe Runza MD, Nico Bruining PhD, Pieter C. Smits MD, PhD, Evelyn Regar MD, PhD, Willem J. van der Giessen MD, PhD, Georgios Sianos MD, PhD, Ron van Domburg PhD, Peter de Jaegere MD, PhD, Gabriel P. Krestin MD, PhD, Patrick W. Serruys MD, PhD, and Pim J. de Feyter MD, PhD^*

From the Department of Cardiology, Thoraxcenter (C.A.G.V.M., F.C., N.R.M., M.V., W.B.M., E.P.M., J.L., N.B., E.R., W.J.v.d.G., G.S., R.v.D., P.d.J., P.W.S., P.J.d.F.) and Department of Radiology (C.A.G.V.M., F.C., N.R.M., P.M., W.B.M., F.P., G.R., G.P.K., P.J.d.F.), Erasmus MC, Rotterdam, the Netherlands; and Medical Center Rijnmond Zuid (P.C.S.), Rotterdam, the Netherlands.

^* To whom correspondence should be addressed. E-mail: p.j.defeyter{at}erasmusmc.nl.

Background--Surveillance conventional coronary angiography (CCA) is recommended 2 to 6 months after stent-supported left main coronary artery (LMCA) percutaneous coronary intervention due to the unpredictable occurrence of in-stent restenosis (ISR), with its attendant risks. Multislice computed tomography (MSCT) is a promising technique for noninvasive coronary evaluation. We evaluated the diagnostic performance of high-resolution MSCT to detect ISR after stenting of the LMCA.

Methods and Results--Seventy-four patients were prospectively identified from a consecutive patient population scheduled for follow-up CCA after LMCA stenting and underwent MSCT before CCA. Until August 2004, a 16-slice scanner was used (n=27), but we switched to the 64-slice scanner after that period (n=43). Patients with initial heart rates >65 bpm received -blockers, which resulted in a mean periscan heart rate of 57±7 bpm. Among patients with technically adequate scans (n=70), MSCT correctly identified all patients with ISR (10 of 70) but misclassified 5 patients without ISR (false-positives). Overall, the accuracy of MSCT for detection of angiographic ISR was 93%. The sensitivity, specificity, and positive and negative predictive values were 100%, 91%, 67%, and 100%, respectively. When analysis was restricted to patients with stenting of the LMCA with or without extension into a single major side branch, accuracy was 98%. When both branches of the LMCA bifurcation were stented, accuracy was 83%. For the assessment of stent diameter and area, MSCT showed good correlation with intravascular ultrasound (r=0.78 and 0.73, respectively). An intravascular ultrasound threshold value 1 mm was identified to reliably detect in-stent neointima hyperplasia with MSCT.

Conclusions--Current MSCT technology, in combination with optimal heart rate control, allows reliable noninvasive evaluation of selected patients after LMCA stenting. MSCT is safe to exclude left main ISR and may therefore be an acceptable first-line alternative to CCA.

Key words: angiography • angioplasty • imaging • restenosis • stents

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