Assessment of coronary artery stent restenosis using 256-multislice computed tomography (256-MSCT): factors affecting assessment and accurate diagnosis using clinical data and phantom study

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Background: Detection of in-stent restenosis (ISR) by cardiac CT would be a major advance for the evaluation of patients suspected of having ISR. However, the diagnostic accuracy and influencing factors of current generation 256-MSCT is not fully established. The purpose of this study was to evaluate the accuracy of 256-MSCT in identifying ISR. Methods: Between December 2008 and November 2012, 427 consecutive patients (male 79%, mean age 68 years) with prior coronary stent implantation in 1012 lesions underwent MSCT (Brilliance iCT v3.0.0, Philips) and coronary angiography. Possible factors that influenced the diagnostic performance of CT were evaluated, which stent size, stent material, location and heart rate. Many available different types and size of first and second-generation stents placed in plastic tubes filled with contrast agent were imaged with MSCT. Results: In total, 834 (82.4%) stents were available for evaluation. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 94.5%, 94.2%, 82.9%, and 98.3%. In stents with a diameter ≤2.5 mm, 141 (58.0%) of 243 stents were available for evaluation and PPV and NPV were 85.0% and 98.4%. Cypher, Taxus Express2, Taxus Liberte/Liberte, Endeavor/Driver, Xience/Promus/Vison, Promus Element and Taxus Element, Resolute Integrity, Nobori/S-Stent Stent evaluable rate were 79.4%, 86.0%, 86.7%, 88.9%, 78.8%, 55.6%, 86.7% and 84.6%. Evaluable rate of stents in left main coronary artery (LMCA), left anterior descending artery (LAD), left circumflex (LCX) and right coronary artery (RCA) were 88.6%, 86.1%, 71.2% and 86.2%. Evaluable rate, PPV and NPV were over 80%, 84% and 98% in normal heart rate (<80bpm), 72%, 57% and 91% in high heart rate (>or=80bpm). Conclusions: 256-MSCT angiography has high diagnostic value for detection of coronary in-stent restenosis. However stent diameter, stent material, stent lesion, high heart rate (>or=80bpm) and coronary calcification influence accuracy. The diagnostic accuracy of 256-MSCT is not too affected by heart rate (<80bpm) and Body mass index.