The Role Of Flash Dual-source Computer Tomography In Diagnosis Of Instent Restenosis

Backgrounds:Coronary angiography (CAG) is still the diagnosis of coronary stentimplantation re-stenosis standarded techniques. However, because it is a invasiveexamination, there are some complications, Postoperative follow-up is low. The Flashdual-source CT (DSCT) because of its high temporal resolution and spatial resolution,non-invasive follow-up of coronary stent implantation, safe, effective, and easy tobecome possible.Objective:Assess the clinical follow-up value of daul-source CT (DSCT) coronaryangiography for detecting re-stenosis after stenting by Flash dual-source computertomography and coronary angiography contrast analysis.Preliminary exploration of theFlash DSC evaluate the ability of the different anatomical sites and different stent wallthickness.Methods:85patients with118previously implanted coronary stents underwentboth DSCT and coronary angiography (CAG) at long-year follow-up.Flash DSCTevaluation stent re-stenosis sensitivity, specificity, positive predictive value, andnegative predictive value, respectively, from the number of cases, the number of stents,stent diameter.Results:(1)the population consisted of85symptomatic patients with a total of118stents.On the patient basis the sensitivity, specificity, positive, and negative predictivevalues to detect significant in-stent re-stenosis were93.3%,96.3%,93.3%,96.3%，respectively.Flash DSCT and CAG inspection results showed no significant difference.(X2test, P>0.05). On the patient basis the sensitivity, specificity, positive, and negativepredictive values to detect significant in-stent re-stenosis were86.7%,90.7%, 95.1%,96.3%. Flash DSCT and CAG inspection results showed no significantdifference.(X2test, P>0.05）（1）CAG as the reference standard, CAG as the reference standard, Flash DSCTevaluation of different diameter stent patency: Flash DSCT evaluated diameter2.5mmstent re-stenosis, sensitivity specificity positive predictive value negative predictivevalue were57.1%,80%,67.7%,72.7%，70.5%。2.75mm diameter stent re-stenosisevaluation, a sensitivity of specificity positive predictive value negative predictivevalue diagnostic accuracy were61.5%,84.2%,72.7%,76.2%75%，respectively.3.0mmstent re-stenosis, sensitivity specificity positive predictive value negative predictivevalue diagnostic accuracy were90%,100%,100%96.9%，95%，respectively.For stentdiameter3.5mm20stents and diameter4.0mm6stents.Flash DSCT evaluation resultsconsistent with results of CAG, four indicators that sensitivity, specificity, positivepredictive value and negativepredictive values were100%.The results of this study,2.5mm~~4.0diameter stents Flash DSCT and CAG evaluate stent re-stenosis results ofthe differencewas not statistically significant.(X2test, P>0.05)（2）The stents with a strut thickness≤0.0047Inch of Flash DSCT evaluationsensitivity specificity positive predictive value negative predictive value and diagnosticaccuracy were87％、94％、83.3％，95.4％，92%,respectively.However,the stents witha strut thickness>0.0047Inch were57.4%、80%、67.9%、72.6%，70.5%。（3）The diagnostic accuracy of Flash DSCT at the heart rate＜60beats/min for theassessment of significant in-stent re-stenosis was86%(95%CI:75%–95%), whereasthe diagnostic accuracy at the heart rate≥60beats/min was84%(95%CI:71%–96%).No significant effect of heart rate between Flash DSCTdiagnostic accuracy was observed.(P=0.841)Stent overlap or not was no statisticallysignificant difference on the Flash DSCT diagnostic accuracy（P=0.872）Conclusion：The theoretically, Flash DSCT alternative coronary angiography (CAG)asa means of evaluation of the patency of post-PCI and coronary stent implantationfollow-up. But in clinical applications Flash DSCT still recommended as a the stentdiameter3.0mm and3.0mm coronary stent implantation means of follow-up, as a preliminary screening of2.75mm and the diameter of the stent. Flash the DSCTdiagnostic accuracy by the diameter of the stent, pillar thickness, overlap or not hasnothing to do with the heart rate and bracket.