Multi-Slice Computed Angiography for The Evaluation of Stent Patency After Left Main Coronary Artery Stenting: Computed Angiography for the Evaluation of Stent Patency

Muhammad  Alam Khan; Ghulam  Rasool Maken; Naeem  Tariq; Waheed Ur Rehman; Abdul  Rehman Jokio; Bilal  Ahmad; Muhammad  Farrukh Habib

doi:10.54393/pjhs.v4i02.513

Authors

Muhammad Alam Khan Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
Ghulam Rasool Maken Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
Naeem Tariq Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
Waheed Ur Rehman Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
Abdul Rehman Jokio Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
Bilal Ahmad Saidu Group of Teaching Hospital, Swat, Pakistan
Muhammad Farrukh Habib Department of Public Health, Al Hamd Islamic University, Islamabad, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v4i02.513

Keywords:

Coronary Artery Disease, Ischemia, In-stent Restenosis, PCI

Abstract

Due to the high frequency of in-stent restenosis, repeat coronary angiography and left main percutaneous coronary intervention is recommended. But Computed Tomography Angiography is a noninvasive procedure for evaluating coronary arteries. Objectives: To assess the proportion of InStent restenosis in left main per-Cutaneous coronary intervention and to evaluate diagnostic efficacy of Computed Tomography Angiography in detecting In stent Restenosis. Methods: We assessed 263 consecutive LM PCI patients; 130 patients were chosen for this study procedure as they meet our criteria. CTA was conducted three months following the LM PCI. Results: The vast majority of patients (73.8 %) had PCI from LM to LAD and 16.2 % from LM to LCX. Only 10% of patients had bifurcation PCI, and all patients had DES (100%). The average period for ISR development was 125 months, with ISR rates of 32.2 % in the LM to LAD cohort and 38 % in the LM to LCX cohort. The median time between PCI and CTA was 194 days, with a mean basal heart rate of 69 ± 12 beats per minute. CTA exhibited a positive predictive value of 84.7%. Conclusion: CTA enables an accurate noninvasive assessment of selected patients following LM PCI. And CTA can be used as a first-line treatment instead of coronary angiography.

References

Sareen N and Ananthasubramaniam K. Left main coronary artery disease: A review of the spectrum of noninvasive diagnostic modalities. Journal of Nuclear Cardiology. 2016 Dec; 23: 1411-29. doi: 10.1007/s12350-015-0152-1.

Neglia D, Rovai D, Caselli C, Pietila M, Teresinska A, Aguadé-Bruix S, et al. Detection of significant coronary artery disease by noninvasive anatomical and functional imaging. Circulation: Cardiovascular Imaging. 2015 Mar; 8(3): e002179. doi: 10.1161/CIRCIMAGING.114.002179.

Beohar N, Robbins JD, Cavanaugh BJ, Ansari AH, Yaghmai V, Carr J, et al. Quantitative assessment of in‐stent dimensions: A comparison of 64 and 16 detector multislice computed tomography to intravascular ultrasound. Catheterization and Cardiovascular Interventions. 2006 Jul; 68(1): 8-10. doi: 10.1002/ccd.20786.

Van Mieghem CA, Cademartiri F, Mollet NR, Malagutti P, Valgimigli M, Meijboom WB, et al. Multislice spiral computed tomography for the evaluation of stent patency after left main coronary artery stenting: a comparison with conventional coronary angiography and intravascular ultrasound. Circulation. 2006 Aug; 114(7): 645-53. doi: 10.1161/CIRCULATIONAHA.105.608950.

Mäkikallio T, Holm NR, Lindsay M, Spence MS, Erglis A, Menown IB, et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. The Lancet. 2016 Dec; 388(10061): 2743-52. doi: 10.1016/S0140-6736(16)32052-9.

Stone GW, Sabik JF, Serruys PW, Simonton CA, Généreux P, Puskas J, et al. Everolimus-eluting stents or bypass surgery for left main coronary artery disease. New England Journal of Medicine. 2016 Dec; 375(23): 2223-35. doi: 10.1056/NEJMoa1610227.

Zalewska-Adamiec M, Bachórzewska-Gajewska H, Kralisz P, Nowak K, Hirnle T, Dobrzycki S. Prognosis in patients with left main coronary artery disease managed surgically, percutaneously or medically: a long-term follow-up. Kardiologia Polska (Polish Heart Journal). 2013 Aug; 71(8): 787-95. doi: 10.5603/KP.2013.0189.

Collet C, Onuma Y, Andreini D, Sonck J, Pompilio G, Mushtaq S, et al. Coronary computed tomography angiography for heart team decision-making in multivessel coronary artery disease. European Heart Journal. 2018 Nov; 39(41): 3689-98. doi: 10.1093/eurheartj/ehy581.

Li P, Xu L, Yang L, Wang R, Hsieh J, Sun Z, et al. Blooming artifact reduction in coronary artery calcification by a new de-blooming algorithm: initial study. Scientific reports. 2018 May; 8(1): 1-8. doi: 10.1038/s41598-018-25352-5.

Papadopoulou SL, Girasis C, Gijsen FJ, Rossi A, Ottema J, van der Giessen AG, et al. A CT‐based medina classification in coronary bifurcations: Does the lumen assessment provide sufficient information?. Catheterization and Cardiovascular Interventions. 2014 Sep; 84(3): 445-52. doi: 10.1002/ccd.25496.

Grodecki K, Opolski MP, Staruch AD, Michalowska AM, Kepka C, Wolny R, et al. Comparison of computed tomography angiography versus invasive angiography to assess medina classification in coronary bifurcations. The American Journal of Cardiology. 2020 May; 125(10): 1479-85. doi: 10.1016/j.amjcard.2020.02.026.

Poon M, Lesser JR, Biga C, Blankstein R, Kramer CM, Min JK, et al. Current evidence and recommendations for coronary CTA first in evaluation of stable coronary artery disease. Journal of the American College of Cardiology. 2020 Sep; 76(11): 1358-62. doi: 10.1016/j.jacc.2020.06.078.

Mauri L and Normand SL. Studies of drug-eluting stents: to each his own?. Circulation. 2008 Apr; 117(16): 2047-50. doi: 10.1161/CIRCULATIONAHA.108.770164.

Takagi K, Ielasi A, Shannon J, Latib A, Godino C, Davidavicius G, et al. Clinical and procedural predictors of suboptimal outcome after the treatment of drug-eluting stent restenosis in the unprotected distal left main stem: the Milan and New-Tokyo (MITO) registry. Circulation: Cardiovascular Interventions. 2012 Aug; 5(4): 491-8. doi: 10.1161/CIRCINTERVENTIONS.111.964874.

Kosmala A, Petritsch B, Weng AM, Bley TA, Gassenmaier T. Radiation dose of coronary CT angiography with a third-generation dual-source CT in a “real-world” patient population. European Radiology. 2019 Aug; 29: 4341-8. doi: 10.1007/s00330-018-5856-6.

Riedl KA, Jensen JM, Ko BS, Leipsic J, Grove EL, Mathiassen ON, et al. Coronary CT angiography derived FFR in patients with left main disease. The International Journal of Cardiovascular Imaging. 2021 Nov; 37(11): 3299-308. doi: 10.1007/s10554-021-02371-4.

Xie JX, Eshtehardi P, Varghese T, Goyal A, Mehta PK, Kang W, et al. Prognostic significance of nonobstructive left main coronary artery disease in women versus men: long-term outcomes from the CONFIRM (coronary CT angiography evaluation for clinical outcomes: an international multicenter) registry. Circulation: Cardiovascular Imaging. 2017 Aug; 10(8): e006246. doi: 10.1161/CIRCIMAGING.117.006246.

Mancini GJ, Leipsic J, Budoff MJ, Hague CJ, Min JK, Stevens SR, et al. CT angiography followed by invasive angiography in patients with moderate or severe ischemia-insights from the ISCHEMIA trial. Cardiovascular Imaging. 2021 Jul; 14(7): 1384-93. doi: 10.1016/j.jcmg.2020.11.012.

Budoff MJ, Li D, Kazerooni EA, Thomas GS, Mieres JH, Shaw LJ. Diagnostic accuracy of noninvasive 64-row computed tomographic coronary angiography (CCTA) compared with myocardial perfusion imaging (MPI): the PICTURE study, a prospective multicenter trial. Academic Radiology. 2017 Jan; 24(1): 22-9. doi: 10.1016/j.acra.2016.09.008.

Hoffmann U, Ferencik M, Cury RC, Pena AJ. Coronary CT angiography. Journal of Nuclear Medicine. 2006 May; 47(5): 797-806.

National Research Council. Tracking Radiation Exposure from Medical Diagnostic Procedures: workshop reports. National Academies Press; 2012 Jun. doi: 10.17226/13416.

Kumar V, Weerakoon S, Dey AK, Earls JP, Katz RJ, Reiner JS, et al. The evolving role of coronary CT angiography in Acute Coronary Syndromes. Journal of Cardiovascular Computed Tomography. 2021 Sep; 15(5): 384-93. doi: 10.1016/j.jcct.2021.02.002.

Beigel R, Matetzky S, Gavrielov‐Yusim N, Fefer P, Gottlieb S, Zahger D, et al. Predictors of high‐risk angiographic findings in patients with non‐ST‐segment elevation acute coronary syndrome. Catheterization and Cardiovascular Interventions. 2014 Apr; 83(5): 677-83. doi: 10.1002/ccd.25081.