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Volume-Rendered Multidetector CT Angiography: Noninvasive Follow-Up of Patients Treated with Renal Artery Stents

¹ All authors: Department of Radiology, Innsbruck University Hospital, Anichstra. 35, 6020 Innsbruck, Austria.

View larger version (125K): [in a new window]   Fig. 1A. —77-year-old man treated with 1.5-cm Palmaz stent (Cordis, Johnson & Johnson, Miami, FL) for ostial atherosclerotic renal artery stenosis 6 months after intervention. Paracoronal multiplanar volume reformatted CT scan shows patent stent.

View larger version (73K): [in a new window]   Fig. 1B. —77-year-old man treated with 1.5-cm Palmaz stent (Cordis, Johnson & Johnson, Miami, FL) for ostial atherosclerotic renal artery stenosis 6 months after intervention. Paracoronal volume-rendered CT scan with low-to-high opacity transfer function reveals artifact (arrow) at distal cranial section of stent. Artifact appears to be restenosis of 25%.

View larger version (131K): [in a new window]   Fig. 1C. —77-year-old man treated with 1.5-cm Palmaz stent (Cordis, Johnson & Johnson, Miami, FL) for ostial atherosclerotic renal artery stenosis 6 months after intervention. Paracoronal volume-rendered CT scans with high-to-low opacity transfer function (C) and volume-rendered virtual endoscopy (D) show patent stent. Image quality and lumen delineation here exceed those in A. Digital subtraction angiogram (not shown) obtained 6 months after A-D showed no restenosis. Intraarterial blood pressure measurements revealed gradient of 5 mm Hg between aorta and renal artery, thus ruling out restenosis.

View larger version (112K): [in a new window]   Fig. 1D. —77-year-old man treated with 1.5-cm Palmaz stent (Cordis, Johnson & Johnson, Miami, FL) for ostial atherosclerotic renal artery stenosis 6 months after intervention. Paracoronal volume-rendered CT scans with high-to-low opacity transfer function (C) and volume-rendered virtual endoscopy (D) show patent stent. Image quality and lumen delineation here exceed those in A. Digital subtraction angiogram (not shown) obtained 6 months after A-D showed no restenosis. Intraarterial blood pressure measurements revealed gradient of 5 mm Hg between aorta and renal artery, thus ruling out restenosis.

View larger version (135K): [in a new window]   Fig. 2A. —62-year-old woman treated with 1-cm Palmaz stent (Cordis, Johnson & Johnson, Miami, FL) for ostial atherosclerotic renal artery stenosis 29 months after intervention. Axial source CT scan at stent level detects in-stent stenosis (arrow) but does not provide exact information about stenosis severity.

View larger version (125K): [in a new window]   Fig. 2B. —62-year-old woman treated with 1-cm Palmaz stent (Cordis, Johnson & Johnson, Miami, FL) for ostial atherosclerotic renal artery stenosis 29 months after intervention. Paracoronal multiplanar volume reformatted CT scan shows restenosis of 80% (arrow) at distal cranial section of stent.

View larger version (138K): [in a new window]   Fig. 2C. —62-year-old woman treated with 1-cm Palmaz stent (Cordis, Johnson & Johnson, Miami, FL) for ostial atherosclerotic renal artery stenosis 29 months after intervention. Paracoronal volume-rendered CT scans with low-to-high (C) and high-to-low (D) opacity transfer functions show restenosis of 60% (arrow) at distal cranial section of stent. Image quality was considered good on both images; however, lumen delineation was considered better on D. Slight increase in thickness of stent wall did not considerably interfere with detection and quantification of restenosis.

View larger version (179K): [in a new window]   Fig. 2D. —62-year-old woman treated with 1-cm Palmaz stent (Cordis, Johnson & Johnson, Miami, FL) for ostial atherosclerotic renal artery stenosis 29 months after intervention. Paracoronal volume-rendered CT scans with low-to-high (C) and high-to-low (D) opacity transfer functions show restenosis of 60% (arrow) at distal cranial section of stent. Image quality was considered good on both images; however, lumen delineation was considered better on D. Slight increase in thickness of stent wall did not considerably interfere with detection and quantification of restenosis.

View larger version (121K): [in a new window]   Fig. 2E. —62-year-old woman treated with 1-cm Palmaz stent (Cordis, Johnson & Johnson, Miami, FL) for ostial atherosclerotic renal artery stenosis 29 months after intervention. Volume-rendered virtual endoscopic CT scan shows restenosis of 50% (arrows).

View larger version (162K): [in a new window]   Fig. 2F. —62-year-old woman treated with 1-cm Palmaz stent (Cordis, Johnson & Johnson, Miami, FL) for ostial atherosclerotic renal artery stenosis 29 months after intervention. Right oblique selective digital subtraction angiogram obtained 4 weeks after A-E shows restenosis of 70% (arrow). Intraarterial blood pressure measurements revealed transstenotic pressure gradient of 34 mm Hg.

View larger version (142K): [in a new window]   Fig. 3A. —61-year-old man treated for ostial atherosclerotic renal artery stenosis with 1.5-cm Palmaz stent (Cordis, Johnson & Johnson, Miami, FL) 36 months after intervention. Paraaxial multiplanar volume reformatted CT scan depicts 80% restenosis located at anterior (straight arrow) and posterior (curved arrow) walls of proximal portion of stent.

View larger version (97K): [in a new window]   Fig. 3B. —61-year-old man treated for ostial atherosclerotic renal artery stenosis with 1.5-cm Palmaz stent (Cordis, Johnson & Johnson, Miami, FL) 36 months after intervention. Paraaxial volume-rendered CT scan with low-to-high opacity transfer function depicts only restenosis portion located at posterior (arrow) wall of stent, indicating 40% restenosis.

View larger version (137K): [in a new window]   Fig. 3C. —61-year-old man treated for ostial atherosclerotic renal artery stenosis with 1.5-cm Palmaz stent (Cordis, Johnson & Johnson, Miami, FL) 36 months after intervention. Paraaxial volume-rendered CT scan with high-to-low opacity transfer function depicts anterior (arrowhead) and posterior (arrow) portions of restenosis, indicating 70% restenosis.

View larger version (120K): [in a new window]   Fig. 3D. —61-year-old man treated for ostial atherosclerotic renal artery stenosis with 1.5-cm Palmaz stent (Cordis, Johnson & Johnson, Miami, FL) 36 months after intervention. Volume-rendered virtual endoscopic CT scan shows anterior (open arrow) and posterior (solid arrows) portions of restenosis that was estimated to be 25%.

View larger version (137K): [in a new window]   Fig. 3E. —61-year-old man treated for ostial atherosclerotic renal artery stenosis with 1.5-cm Palmaz stent (Cordis, Johnson & Johnson, Miami, FL) 36 months after intervention. Left oblique digital subtraction angiogram obtained 9 weeks after A—D indicates presence of restenosis. Hemodynamic significance of stenosis was further confirmed by transstenotic pressure gradient of 39 mm Hg.

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