Accuracy of Newer Generation Dual Source Multi-Detector Computerized Tomography for Detection of Coronary In-stent restenosis in Comparison with Invasive Coronary Angiography and Intravascular Ultrasound: A Comparative Cross-Sectional Study.

AbouElfetouh Eldeeb, Mohey Eldeen; Mostafa, Mohamed Ahmed; Nagiub, Tarek Ahmed; Eldein Alshair, Mohammed Hosam; Shehata, Islam Elsayed

Background: Previous studies have evaluated coronary artery in-stent diameter restenosis (ISDR) using the 64-slice multi-detector computed tomography coronary angiography (MDCT-CA) compared to invasive coronary angiography(ICA) as the gold standard. In our study, we aimed to compare the diagnostic precision of new generation dual source MDCTCA and ICA with add on intravascular ultrasonography to evaluate ISDR. Methods: One hundred patients with previously stented coronaries (n=110 stents) underwent MDCT-CA followed by ICA and IVUS within 24 hours. Specificities, Sensitivities, negative predictive values (NPV) and positive predictive values (PPV) of MDCT-CA and ICA for confirming or excluding ISDR by measuring in-stent area restenosis (ISAR) and minimal luminal area (MLA) ≤4.0 mm2 of IVUS was taken as the standard reference standard. Results: Newer generation dual source MDCT-CA and IVUS had a good sensitivity, specificity and accuracy in detection of ISDR. However, the patients have to be carefully selected. Consistent with previous MDCT-CA studies, our study observed significant effect of stent diameter on assessability, with 3 mm being a cutoff point below which the percentage of assessable stents is extremely low. When using IVUS MLA of 4.0 mm2 as a reference method for identification of ISDR, no significant difference was detected between MDCT-CA and ICA in identification of ISDR.The higher NPV of MDCT-CA when compared with ICA and IVUS (100% and 100% respectively),therefore,MDCT-CA had an important role in exclusion of ISDR. Conclusions: In conclusion,when evaluating the patency of stents,newer generation dual source MDCT-CA has the same performance as coronary angiography and IVUS and has the following advantages:non-invasiveness,low cost,and easy and convenient operation.

COMPUTED tomography; MULTIDETECTOR computed tomography; ULTRASONIC imaging; CORONARY angiography; CORONARY restenosis; PERCUTANEOUS coronary intervention; CARDIOLOGY; INTRAVASCULAR ultrasonography

Zagazig University Medical Journal, 2023, Vol 29, Issue 2, p547

1110-1431

Academic Journal

10.21608/zumj.2021.85316.2281