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(Circulation. 2003;108:e147.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Neointimal Hyperplasia in Carotid Stent Detected With Multislice Computed Tomography

Filippo Cademartiri, MD; Nico Mollet, MD; Koen Nieman, MD; Gabriel P. Krestin, MD, PhD; Pim J. de Feyter, MD, PhD

From the Departments of Radiology (F.C., N.M., K.N., G.P.K., P.J.d.F.) and Cardiology (N.M., K.N., P.J.d.F.), Erasmus Medical Center, Rotterdam, the Netherlands.

Correspondence to Filippo Cademartiri, MD, Department of Radiology, Erasmus Medical Center, Rotterdam, Dr Molenwaterplein, 40, 3015 GD, Rotterdam, The Netherlands. E-mail filippocademartiri{at}hotmail.com

The latest generation of 16-row multislice computed tomography (MSCT) scanner offers high temporal and submillimeter spatial resolution, which allows the visualization of carotid artery atherosclerosis.

At present, carotid artery obstructions are increasingly treated with stent implantation. However, in-stent restenosis may occur within 6 months after stent implantation. MSCT allows the presence and extent of intimal hyperplasia to be monitored.

A 65-year-old symptomatic man with high-grade right carotid artery stenosis underwent wall stent implantation. The stent was positioned in the common carotid artery and internal carotid artery. After 11 months, the patient underwent 16-row MSCT (Sensation 16, Siemens Medical Solutions, Forchheim, Germany) (Figure). A rim of in-stent neointimal hyperplasia was shown, demonstrating the feasibility of using noninvasive MSCT to image in-stent neointimal hyperplasia. The density of the tissue was 75.6±5.6 Hounsfield units, which suggested the presence of fibrotic tissue.

View larger version (84K): [in this window] [in a new window]   Direct 3-dimensional volume rendering (A, B, and C) shows the anatomy of the arteries of the neck at the level of the carotid bifurcation (Car Bif) (see also Movies IV, V, and VI). Clav indicates clavicle; Hyoid, hyoid bone; Jug, jugular vein; Mand, mandible; and Thyr Car, thyroid cartilage. A magnified view of the right (B) and left (C) carotid bifurcations permits recognition of the common carotid artery (CCA), the internal and external carotid arteries (ICA and ECA), and the wall stent (S) at the right side. The left carotid bifurcation (C) is patent but is slightly dilated at the origin of ICA. A few calcified spots also are present. Note the backflow of iodinated contrast material into the right jugular vein (Jug in A). Multiplanar reformats (D through I) show the lumen of the stent. One window setting is used for the visualization of soft tissue (D, E, and F), and another window setting permits the visualization of high-density structures such as stents (G, H, and I). Intimal hyperplasia can be appreciated in Movie I and in sagittal reformats (arrowheads in F and I; Movie II). Because of the spatial orientation of the intimal hyperplasia, the coronal reformats (E and H; Movie III) do not allow an optimal visualization.

Footnotes

Movies I through VII are available in the online-only Data Supplement at http://www.circulationaha.org.

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

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This Article Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cademartiri, F. Articles by de Feyter, P. J. Search for Related Content PubMed PubMed Citation Articles by Cademartiri, F. Articles by de Feyter, P. J. Related Collections Imaging Other etiology CT and MRI