Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Coronary CT Angiography-Based Assessment of Coronary in-Stent Restenosis: A Journey through Past and Present Trends

관상동맥 CT 조영술을 활용한 스텐트 재협착 평가: 과거와 현재 최신 동향으로의 여정

  • Yoon Seong Lee (Department of Radiology, Seoul National University Hospital) ;
  • Eun-Ah Park (Department of Radiology, Seoul National University Hospital) ;
  • Whal Lee (Department of Radiology, Seoul National University Hospital)
  • 이윤성 (서울대학교병원 영상의학과) ;
  • 박은아 (서울대학교병원 영상의학과) ;
  • 이활 (서울대학교병원 영상의학과)
  • Received : 2024.02.16
  • Accepted : 2024.03.08
  • Published : 2024.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Treatment of patients with coronary artery disease commonly involves the use of balloon-expandable stent placements, currently recognized as the most prevalent approach for coronary artery revascularization. Nevertheless, the occurrence of restenosis remains a significant complication following percutaneous coronary interventions. The diagnostic role of coronary CT angiography (CCTA) in detecting stent restenosis has limitations primarily attributable to challenges in accurately discerning the lumen, due to issues such as blooming and motion artifacts. As a result, many cases often necessitate a transition to conventional coronary angiography. However, recent advancements in CT technology have led to notable improvements in both sensitivity and specificity, underscoring the growing significance of CCTA as a diagnostic tool. The consistent reporting of high negative predictive value is particularly noteworthy. This review aims to explore the historical context, current status, and recent trends in diagnosing coronary artery stent restenosis using CCTA.

관상동맥병 환자의 치료에 풍선팽창스텐트 치료는 현재 가장 흔히 시행되는 관상동맥재개통 치료법이다. 그러나 경피적 관상동맥 중재술 이후 재협착은 여전히 주요 합병증으로 남아 있다. 스텐트 재협착을 진단하기 위한 도구로서 관상동맥 CT 조영술(coronary CT angiography; 이하 CCTA)는 과거에는 주로 번짐허상과 움직임허상으로 인해 내강을 정확히 판단하기 어려워 그 역할이 제한적이었다. 따라서 정확한 확인을 위해서 침습적인 고식적 관상동맥 조영술로 넘어가는 경우가 많았다. 그러나 근래 CT 기술의 발달로 민감도와 특이도가 모두 개선되면서 그 역할이 중요해지고 있으며, 특히 일관되게 음성예측도가 높게 보고되고 있다. 본 종설에서는 CCTA를 이용한 관상동맥 스텐트 재협착 진단의 과거와 현재, 그리고 최신 동향에 대해 알아보고자 한다.

Keywords

References

  1. Serruys PW, de Jaegere P, Kiemeneij F, Macaya C, Rutsch W, Heyndrickx G, et al. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med 1994;331:489-495 https://doi.org/10.1056/NEJM199408253310801
  2. Fischman DL, Leon MB, Baim DS, Schatz RA, Savage MP, Penn I, et al. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 1994;331:496-501 https://doi.org/10.1056/NEJM199408253310802
  3. Sigwart U, Puel J, Mirkovitch V, Joffre F, Kappenberger L. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med 1987;316:701-706 https://doi.org/10.1056/NEJM198703193161201
  4. Shlofmitz E, Iantorno M, Waksman R. Restenosis of drug-eluting stents: a new classification system based on disease mechanism to guide treatment and state-of-the-art review. Circ Cardiovasc Interv 2019;12:e007023
  5. Moussa ID, Mohananey D, Saucedo J, Stone GW, Yeh RW, Kennedy KF, et al. Trends and outcomes of restenosis after coronary stent implantation in the United States. J Am Coll Cardiol 2020;76:1521-1531 https://doi.org/10.1016/j.jacc.2020.08.002
  6. Zellweger MJ, Weinbacher M, Zutter AW, Jeger RV, Mueller-Brand J, Kaiser C, et al. Long-term outcome of patients with silent versus symptomatic ischemia six months after percutaneous coronary intervention and stenting. J Am Coll Cardiol 2003;42:33-40 https://doi.org/10.1016/S0735-1097(03)00557-6
  7. Piccolo R, Stefanini GG, Franzone A, Spitzer E, Blochlinger S, Heg D, et al. Safety and efficacy of resolute zotarolimus-eluting stents compared with everolimus-eluting stents: a meta-analysis. Circ Cardiovasc Interv 2015;8:e002223
  8. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020;41:407-477 https://doi.org/10.1093/eurheartj/ehz425
  9. Pack JD, Xu M, Wang G, Baskaran L, Min J, De Man B. Cardiac CT blooming artifacts: clinical significance, root causes and potential solutions. Vis Comput Ind Biomed Art 2022;5:29
  10. Pugliese F, Weustink AC, Van Mieghem C, Alberghina F, Otsuka M, Meijboom WB, et al. Dual source coronary computed tomography angiography for detecting in-stent restenosis. Heart 2008;94:848-854 https://doi.org/10.1136/hrt.2007.126474
  11. Pflederer T, Marwan M, Renz A, Bachmann S, Ropers D, Kuettner A, et al. Noninvasive assessment of coronary in-stent restenosis by dual-source computed tomography. Am J Cardiol 2009;103:812-817 https://doi.org/10.1016/j.amjcard.2008.11.036
  12. Schuijf JD, Pundziute G, Jukema JW, Lamb HJ, Tuinenburg JC, van der Hoeven BL, et al. Evaluation of patients with previous coronary stent implantation with 64-section CT. Radiology 2007;245:416-423 https://doi.org/10.1148/radiol.2452061199
  13. Zhao J, Zheng LL, Yang Y. Evaluation of coronary artery in-stent patency using 64-slice computed tomography. Coron Artery Dis 2011;22:540-552 https://doi.org/10.1097/MCA.0b013e32834c1a28
  14. Andreini D, Pontone G, Bartorelli AL, Trabattoni D, Mushtaq S, Bertella E, et al. Comparison of feasibility and diagnostic accuracy of 64-slice multidetector computed tomographic coronary angiography versus invasive coronary angiography versus intravascular ultrasound for evaluation of in-stent restenosis. Am J Cardiol 2009;103:1349-1358 https://doi.org/10.1016/j.amjcard.2009.01.343
  15. Maintz D, Burg MC, Seifarth H, Bunck AC, Ozgun M, Fischbach R, et al. Update on multidetector coronary CT angiography of coronary stents: in vitro evaluation of 29 different stent types with dual-source CT. Eur Radiol 2009;19:42-49 https://doi.org/10.1007/s00330-008-1132-5
  16. Groen JM, Greuter MJ, van Ooijen PM, Willems TP, Oudkerk M. Initial results on visualization of coronary artery stents at multiple heart rates on a moving heart phantom using 64-MDCT. J Comput Assist Tomogr 2006;30:812-817 https://doi.org/10.1097/01.rct.0000226398.43235.6f
  17. Groen JM, Greuter MJ, van Ooijen PM, Oudkerk M. A new approach to the assessment of lumen visibility of coronary artery stent at various heart rates using 64-slice MDCT. Eur Radiol 2007;17:1879-1884 https://doi.org/10.1007/s00330-006-0568-8
  18. Becker CR, Hong C, Knez A, Leber A, Bruening R, Schoepf UJ, et al. Optimal contrast application for cardiac 4-detector-row computed tomography. Invest Radiol 2003;38:690-694 https://doi.org/10.1097/01.rli.0000084886.44676.e4
  19. Cademartiri F, Maffei E, Palumbo AA, Malago R, La Grutta L, Meiijboom WB, et al. Influence of intra-coronary enhancement on diagnostic accuracy with 64-slice CT coronary angiography. Eur Radiol 2008;18:576-583 https://doi.org/10.1007/s00330-007-0773-0
  20. Cademartiri F, Mollet NR, Lemos PA, Saia F, Midiri M, de Feyter PJ, et al. Higher intracoronary attenuation improves diagnostic accuracy in MDCT coronary angiography. AJR Am J Roentgenol 2006;187:W430-W433 https://doi.org/10.2214/AJR.05.1406
  21. Andreini D, Pontone G, Mushtaq S, Bartorelli AL, Conte E, Bertella E, et al. Coronary stent evaluation with coronary computed tomographic angiography: comparison between low-osmolar, high-iodine concentration iomeprol-400 and iso-osmolar, lower-iodine concentration iodixanol-320. J Cardiovasc Comput Tomogr 2014;8:44-51 https://doi.org/10.1016/j.jcct.2013.12.003
  22. Seifarth H, Ozgun M, Raupach R, Flohr T, Heindel W, Fischbach R, et al. 64- Versus 16-slice CT angiography for coronary artery stent assessment: in vitro experience. Invest Radiol 2006;41:22-27 https://doi.org/10.1097/01.rli.0000191365.88345.e1
  23. Mahnken AH, Muhlenbruch G, Seyfarth T, Flohr T, Stanzel S, Wildberger JE, et al. 64-slice computed tomography assessment of coronary artery stents: a phantom study. Acta Radiol 2006;47:36-42 https://doi.org/10.1080/02841850500406779
  24. Soon KH, Cox N, Chaitowitz I, Selvanayagam JB, Farouque O, MacGregor L, et al. Non-invasive computed tomography angiography in the assessment of coronary stent patency: an Australian experience. Intern Med J 2007;37:360-364 https://doi.org/10.1111/j.1445-5994.2007.01363.x
  25. Tedeschi C, Ratti G, De Rosa R, Sacco M, Borrelli F, Tammaro P, et al. Usefulness of multislice computed tomography to assess patency of coronary artery stents versus conventional coronary angiography. J Cardiovasc Med (Hagerstown) 2008;9:485-492 https://doi.org/10.2459/JCM.0b013e3282f2c9e3
  26. Oncel D, Oncel G, Tastan A, Tamci B. Evaluation of coronary stent patency and in-stent restenosis with dual-source CT coronary angiography without heart rate control. AJR Am J Roentgenol 2008;191:56-63 https://doi.org/10.2214/AJR.07.3560
  27. Yamaoka O, Ikeno K, Fujioka H, Kinoshita M, Murata K, Morita R, et al. Detection of Palmaz-Schatz stent by ultrafast CT. J Comput Assist Tomogr 1995;19:128-130 https://doi.org/10.1097/00004728-199501000-00024
  28. Ohnuki K, Yoshida S, Ohta M, Shimizu M, Mochizuki S, Nishioka M, et al. New diagnostic technique in multi-slice computed tomography for in-stent restenosis: pixel count method. Int J Cardiol 2006;108:251-258 https://doi.org/10.1016/j.ijcard.2005.05.013
  29. Kitagawa T, Yamamoto H, Horiguchi J, Hirai N, Fujii T, Ito K, et al. Usefulness of measuring coronary lumen density with multi-slice computed tomography to detect in-stent restenosis. Int J Cardiol 2008;124:239-243 https://doi.org/10.1016/j.ijcard.2006.11.231
  30. Seifarth H, Raupach R, Schaller S, Fallenberg EM, Flohr T, Heindel W, et al. Assessment of coronary artery stents using 16-slice MDCT angiography: evaluation of a dedicated reconstruction kernel and a noise reduction filter. Eur Radiol 2005;15:721-726 https://doi.org/10.1007/s00330-004-2594-8
  31. Leipsic J, Heilbron BG, Hague C. Iterative reconstruction for coronary CT angiography: finding its way. Int J Cardiovasc Imaging 2012;28:613-620 https://doi.org/10.1007/s10554-011-9832-3
  32. Moscariello A, Takx RA, Schoepf UJ, Renker M, Zwerner PL, O'Brien TX, et al. Coronary CT angiography: image quality, diagnostic accuracy, and potential for radiation dose reduction using a novel iterative image reconstruction technique-comparison with traditional filtered back projection. Eur Radiol 2011;21:2130-2138 https://doi.org/10.1007/s00330-011-2164-9
  33. Renker M, Ramachandra A, Schoepf UJ, Raupach R, Apfaltrer P, Rowe GW, et al. Iterative image reconstruction techniques: applications for cardiac CT. J Cardiovasc Comput Tomogr 2011;5:225-230 https://doi.org/10.1016/j.jcct.2011.05.002
  34. Lee E, Kim YK, Chun EJ, Choi SI. Coronary stent on coronary CT angiography: assessment with model-based iterative reconstruction technique. J Korean Soc Radiol 2016;74:291-298 https://doi.org/10.3348/jksr.2016.74.5.291
  35. Yang J, Yang X, De Cecco CN, Duguay TM, Chen Z, Tesche C, et al. Iterative reconstruction improves detection of in-stent restenosis by high-pitch dual-source coronary CT angiography. Sci Rep 2017;7:6956
  36. Bamberg F, Dierks A, Nikolaou K, Reiser MF, Becker CR, Johnson TR. Metal artifact reduction by dual energy computed tomography using monoenergetic extrapolation. Eur Radiol 2011;21:1424-1429 https://doi.org/10.1007/s00330-011-2062-1
  37. Liu Q, Wang Y, Qi H, Yu Y, Xing Y. Exploring the best monochromatic energy level in dual energy spectral imaging for coronary stents after percutaneous coronary intervention. Sci Rep 2021;11:17576
  38. Andreini D, Collet C, Leipsic J, Nieman K, Bittencurt M, De Mey J, et al. Pre-procedural planning of coronary revascularization by cardiac computed tomography: an expert consensus document of the Society of Cardiovascular Computed Tomography. EuroIntervention 2022;18:e872-e887 https://doi.org/10.4244/EIJ-E-22-00036
  39. Andreini D, Mushtaq S, Pontone G, Rogers C, Pepi M, Bartorelli AL. Severe in-stent restenosis missed by coronary CT angiography and accurately detected with FFRCT. Int J Cardiovasc Imaging 2017;33:119-120 https://doi.org/10.1007/s10554-016-0971-4
  40. Andreini D, Mushtaq S, Pontone G, Conte E, Collet C, Sonck J, et al. CT perfusion versus coronary CT angiography in patients with suspected in-stent restenosis or CAD progression. JACC Cardiovasc Imaging 2020;13:732-742 https://doi.org/10.1016/j.jcmg.2019.05.031
  41. Mushtaq S, Pontone G, Conte E, Trabattoni D, Galli S, Gili S, et al. Diagnostic accuracy of subendocardial vs. transmural myocardial perfusion defect for the detection of in-stent restenosis or progression of coronary artery disease after percutaneous coronary intervention. J Cardiovasc Comput Tomogr 2023;17:277-280 https://doi.org/10.1016/j.jcct.2023.05.005
  42. Tatsugami F, Higaki T, Nakamura Y, Yu Z, Zhou J, Lu Y, et al. Deep learning-based image restoration algorithm for coronary CT angiography. Eur Radiol 2019;29:5322-5329 https://doi.org/10.1007/s00330-019-06183-y
  43. Lee TC, Zhou J, Yu Z, Cai L. Deep learning enabled wide-coverage high-resolution cardiac CT. Available at. https://doi.org/10.1117/12.2611817. Published 2022. Accessed January 12, 2024
  44. Nagayama Y, Emoto T, Hayashi H, Kidoh M, Oda S, Nakaura T, et al. Coronary stent evaluation by CTA: image quality comparison between super-resolution deep learning reconstruction and other reconstruction algorithms. AJR Am J Roentgenol 2023;221:599-610 https://doi.org/10.2214/AJR.23.29506
  45. Kawai H, Motoyama S, Sarai M, Sato Y, Matsuyama T, Matsumoto R, et al. Coronary computed tomography angiographic detection of in-stent restenosis via deep learning reconstruction: a feasibility study. Eur Radiol 2024;34:2647-2657
  46. Si-Mohamed S, Boccalini S, Rodesch PA, Dessouky R, Lahoud E, Broussaud T, et al. Feasibility of lung imaging with a large field-of-view spectral photon-counting CT system. Diagn Interv Imaging 2021;102:305-312 https://doi.org/10.1016/j.diii.2021.01.001
  47. Stein T, Taron J, Verloh N, Doppler M, Rau A, Hagar MT, et al. Photon-counting computed tomography of coronary and peripheral artery stents: a phantom study. Sci Rep 2023;13:14806
  48. Mannil M, Hickethier T, von Spiczak J, Baer M, Henning A, Hertel M, et al. Photon-counting CT: high-resolution imaging of coronary stents. Invest Radiol 2018;53:143-149 https://doi.org/10.1097/RLI.0000000000000420
  49. Bratke G, Hickethier T, Bar-Ness D, Bunck AC, Maintz D, Pahn G, et al. Spectral photon-counting computed tomography for coronary stent imaging: evaluation of the potential clinical impact for the delineation of instent restenosis. Invest Radiol 2020;55:61-67 https://doi.org/10.1097/RLI.0000000000000610
  50. Si-Mohamed SA, Boccalini S, Lacombe H, Diaw A, Varasteh M, Rodesch PA, et al. Coronary CT angiography with photon-counting CT: first-in-human results. Radiology 2022;303:303-313 https://doi.org/10.1148/radiol.211780
  51. de Graaf FR, Schuijf JD, van Velzen JE, Boogers MJ, Kroft LJ, de Roos A, et al. Diagnostic accuracy of 320-row multidetector computed tomography coronary angiography to noninvasively assess in-stent restenosis. Invest Radiol 2010;45:331-340 https://doi.org/10.1097/RLI.0b013e3181dfa312
  52. Veselka J, Cadova P, Tomasov P, Theodor A, Zemanek D. Dual-source CT angiography for detection and quantification of in-stent restenosis in the left main coronary artery: comparison with intracoronary ultrasound and coronary angiography. J Invasive Cardiol 2011;23:460-464
  53. Zhang XH, Yang L, Wu J, Ju HY, Zhang F, He B, et al. Diagnostic accuracy and its affecting factors of dualsource CT for assessment of coronary stents patency and in-stent restenosis. Chin Med J (Engl) 2012;125:1936-1940
  54. Yoshimura M, Nao T, Miura T, Okada M, Nakashima Y, Fujimura T, et al. New quantitative method to diagnose coronary in-stent restenosis by 64-multislice computed tomography. J Cardiol 2015;65:57-62 https://doi.org/10.1016/j.jjcc.2014.03.013
  55. Tatsugami F, Higaki T, Sakane H, Nakamura Y, Iida M, Baba Y, et al. Diagnostic accuracy of in-stent restenosis using model-based iterative reconstruction at coronary CT angiography: initial experience. Br J Radiol 2018;91:20170598
  56. Li Y, Yu M, Li W, Lu Z, Wei M, Zhang J. Third generation dual-source CT enables accurate diagnosis of coronary restenosis in all size stents with low radiation dose and preserved image quality. Eur Radiol 2018;28:2647-2654 https://doi.org/10.1007/s00330-017-5256-3
  57. Li J, Guo MT, Yang X, Gao F, Li N, Huang MG. The usefulness of subtraction coronary computed tomography angiography for in-stent restenosis assessment of patients with CoCr stent using 320-row area detector CT. Medicine (Baltimore) 2021;100:e28345