Abstract
Purpose
Few articles have evaluated vertebral artery ostium stents using multislice computed tomography (CT). The purpose of our study was to evaluate the diagnostic performance of 64- and 16-slice CT for detecting significant in-stent restenosis after vertebral artery ostium stenting, and to identify factors affecting the accurate diagnosis by CT.
Methods
We reviewed 57 stents scanned using 64-slice CT and 34 stents using 16-slice CT. The accuracy of CT for diagnosing significant in-stent restenosis (≥ 50 % diameter narrowing) was calculated using conventional angiography as a reference standard. Possible factors influencing the diagnostic performance of CT were analyzed, such as CT scanner, image quality, and stent characteristics.
Results
With 64-slice CT, 46 (80.7 %) of 57 stents were classified as evaluable, while with 16-slice CT, 28 (82.3 %) of 34 stents were classified as evaluable. No stents with diameters ≤ 2.75 mm were evaluable. The respective results for 64- versus 16-slice CT were sensitivity 87.5 % (95 % confidence interval [CI] 47.3–99.7 %) versus 100 % (95 % CI 15.8–100.0 %), specificity 94.7 % (95 % CI 82.3 %–99.4 %) versus 96.2 % (95 % CI 80.4–99.9 %). Factors reducing the accurate diagnosis were those associated with poor image quality, a diameter ≤ 2.75 mm, and drug-eluting stent type (p < 0.05).
Conclusions
64-slice and 16-slice CT scans are adequate in stents with diameters > 2.75 mm for the evaluation of in-stent restenosis after stent implantation in the vertebral artery ostium.
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References
Koroshetz WJ, Ropper AH. Artery-to-artery embolism causing stroke in the posterior circulation. Neurology. 1987;37:292.
Coward LJ, McCabe DJ, Ederle J, Featherstone RL, Clifton A, Brown MM. Long-term outcome after angioplasty and stenting for symptomatic vertebral artery stenosis compared with medical treatment in the carotid and vertebral artery transluminal angioplasty study (CAVATAS) a randomized trial. Stroke. 2007;38:1526–30.
Chastain HD, Campbell MS, Iyer S, Roubin GS, Vitek J, Mathur A, et al. Extracranial vertebral artery stent placement: in-hospital and follow-up results. J neurosurg. 1999;91:547–52.
Lin YH, Juang JM, Jeng JS, Yip PK, Kao HL. Symptomatic ostial vertebral artery stenosis treated with tubular coronary stents: clinical results and restenosis analysis. J Endovasc Ther. 2004;11:719–26.
SSYLVIA Study Investigators. Stenting of symptomatic atherosclerotic lesions in the vertebral or intracranial arteries (SSYLVIA): study results. Stroke. 2004;35:1388–92.
Holmes DR Jr, Leon MB, Moses JW, Popma JJ, Cutlip D, Fitzgerald PJ, et al. Analysis of 1-year clinical outcomes in the SIRIUS trial a randomized trial of a sirolimus-eluting stent versus a standard stent in patients at high risk for coronary restenosis. Circulation. 2004;109:634–40.
Morice MC, Colombo A, Meier B, Serruys P, Tamburino C, Guagliumi G, et al. Sirolimus-vs paclitaxel-eluting stents in de novo coronary artery lesions. JAMA. 2006;295:895–904.
Stayman AN, Nogueira RG, Gupta R. A systematic review of stenting and angioplasty of symptomatic extracranial vertebral artery stenosis. Stroke. 2011;42:2212–6.
Willinsky RA, Taylor SM, Farb RI, Tomlinson G, Montanera W. Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology. 2003;227:522–8.
Maintz D, Botnar RM, Fischbach R, Heindel W, Manning WJ, Stuber M. Coronary magnetic resonance angiography for assessment of the stent lumen: a phantom study. J Cardiovasc Magn Reson. 2002;4:359–67.
Sun Z, Almutairi AMD. Diagnostic accuracy of 64 multislice CT angiography in the assessment of coronary in-stent restenosis: a meta-analysis. Eur J Radiol. 2010;73:266–73.
Sun Z, Davidson R, Lin CH. Multi-detector row CT angiography in the assessment of coronary in-stent restenosis: a systematic review. Eur J Radiol. 2009;69:489–95.
Kitagawa T, Fujii T, Tomohiro Y, Maeda K, Kobayashi M, Kunita E, et al. Noninvasive assessment of coronary stents in patients by 16-slice computed tomography. Int J Cardiol. 2006;109:188–94.
Gilard M, Cornily J-C, Pennec P-Y, Le Gal G, Nonent M, Mansourati J, et al. Assessment of coronary artery stents by 16 slice computed tomography. Heart. 2006;92:58–61.
Watanabe M, Uemura S, Iwama H, Okayama S, Takeda Y, Kawata H, et al. Usefulness of 16-slice multislice computed tomography for follow-up study of coronary stent implantation. Circ J. 2006;70:691–7.
Seifarth H, Özgün 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;41:22–7
Maintz D, Seifarth H, Raupach R, Flohr T, Rink M, Sommer T, et al. 64-slice multidetector coronary CT angiography: in vitro evaluation of 68 different stents. Eur Radiol. 2006;16:818–26.
Maintz D, Seifarth H, Flohr T, Krämer S, Wichter T, Heindel W, et al. Improved coronary artery stent visualization and in-stent stenosis detection using 16-slice computed-tomography and dedicated image reconstruction technique. Invest Radiol. 2003;38:790–5.
Maintz D, Grude M, Fallenberg E, Heindel W, Fischbach R. Assessment of coronary arterial stents by multislice-CT angiography. Acta Radiol. 2003;44:597–603.
Oncel D, Oncel G, Karaca M. Coronary stent patency and in-stent restenosis: determination with 64-section multidetector CT coronary angiography—initial experience. Radiology. 2007;242:403–9.
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Lee, Y., Lim, Y., Lim, H. et al. Evaluation of In-Stent Restenosis After Stent Implantation in the Vertebral Artery Ostium by Multislice Computed Tomography Angiography: Factors Affecting Accurate Diagnosis. Clin Neuroradiol 25, 379–386 (2015). https://doi.org/10.1007/s00062-014-0315-5
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DOI: https://doi.org/10.1007/s00062-014-0315-5