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

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

doi:10.21608/zumj.2021.85316.2281

	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
Zagazig University Medical Journal
Article 12, Volume 29, Issue 2, March 2023, Page 547-458 PDF (800.48 K)
Document Type: Original Article
DOI: 10.21608/zumj.2021.85316.2281
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Authors
Mohey Eldeen AbouElfetouh Eldeeb ¹; Mohamed Ahmed Mostafa ²; Tarek Ahmed Nagiub ¹; Mohammed Hosam Eldein Alshair ¹; Islam Elsayed Shehata ³
¹Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt.
²Department of Cardiology, Kobry AlKobah Military Hospital, Military Medical Academy, Cairo, Egypt.
³Zagazig University Faculty of Human Medicine
Abstract
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 MDCT-CA 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.
Keywords
Coronary angiography; in-stent restenosis; intravascular ultrasound; multi-detector computerized tomography; percutaneous coronary intervention


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