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Evaluation of Coronary Stent Patency and In-Stent Restenosis with Dual-Source CT Coronary Angiography Without Heart Rate Control

Dilek Oncel1, Guray Oncel1, Ahmet Tastan2 and Batuhan Tamci2

1 Department of Radiology, Sifa Hospital, Fevzipasa Blvd. 172/2, 35340 Basmane, Izmir, Turkey.
2 Department of Cardiology, Sifa Hospital, Basmane, Izmir, Turkey.


Figure 1
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  		Fig. 1A —74-year-old man with patent stent and no intimal hyperplasia in proximal segment of left circumflex artery. Interval between stent placement and CT was 19 months. Patient was referred because of angina-like symptoms. Image quality score is 1 (good image quality). Mean heart rate during scan was 68 beats/min. Curved multiplanar reconstruction image shows patent stent with no low-attenuation areas related to neointimal tissue. Atherosclerotic wall changes are present at vessel segment proximal to stent. White line indicates level of B.

 

Figure 2
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  		Fig. 1B —74-year-old man with patent stent and no intimal hyperplasia in proximal segment of left circumflex artery. Interval between stent placement and CT was 19 months. Patient was referred because of angina-like symptoms. Image quality score is 1 (good image quality). Mean heart rate during scan was 68 beats/min. Cross-sectional multiplanar reconstruction image from area indicated in A shows homogeneous area of high attenuation indicating normal flow in stent lumen. No low-attenuation filling defects are evident.

 

Figure 3
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  		Fig. 1C —74-year-old man with patent stent and no intimal hyperplasia in proximal segment of left circumflex artery. Interval between stent placement and CT was 19 months. Patient was referred because of angina-like symptoms. Image quality score is 1 (good image quality). Mean heart rate during scan was 68 beats/min. Invasive coronary angiography in right anterior oblique view of left circumflex artery confirms patency of stent.

 

Figure 4
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  		Fig. 2A —65-year-old man with restenosis in stent in proximal segment of left anterior descending artery. Interval between stent placement and CT was 30 months. Patient was referred because of positive result of stress ECG test. Image quality score is 1 (good image quality). Mean heart rate during scan was 92 beats/min. Curved multiplanar reconstruction image shows in-stent restenosis as low-attenuation area (arrow) along stent wall with residual lumen smaller than 50%.

 

Figure 5
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  		Fig. 2B —65-year-old man with restenosis in stent in proximal segment of left anterior descending artery. Interval between stent placement and CT was 30 months. Patient was referred because of positive result of stress ECG test. Image quality score is 1 (good image quality). Mean heart rate during scan was 92 beats/min. Cross-sectional multiplanar reconstruction image shows in-stent restenosis as low-attenuation filling defect (arrow) inside stent lumen.

 

Figure 6
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  		Fig. 2C —65-year-old man with restenosis in stent in proximal segment of left anterior descending artery. Interval between stent placement and CT was 30 months. Patient was referred because of positive result of stress ECG test. Image quality score is 1 (good image quality). Mean heart rate during scan was 92 beats/min. Left anterior oblique invasive coronary angiogram shows in-stent restenosis (arrow) in mid segment of left anterior descending artery stent.

 

Figure 7
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  		Fig. 3A —67-year-old man with minimal neointimal hyperplasia but no significant stenosis in stent in proximal segment of left anterior descending artery. Interval between stent placement and CT was 27 months. Patient was referred because of angina-like symptoms. He was current smoker with hypercholesterolemia. Image quality score is 1 (good image quality). Mean heart rate during scan was 76 beats/min. Curved multiplanar reconstruction image shows minimal neointimal hyperplasia as low-attenuation filling defect (arrow) along stent wall with residual lumen greater than 50%.

 

Figure 8
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  		Fig. 3B —67-year-old man with minimal neointimal hyperplasia but no significant stenosis in stent in proximal segment of left anterior descending artery. Interval between stent placement and CT was 27 months. Patient was referred because of angina-like symptoms. He was current smoker with hypercholesterolemia. Image quality score is 1 (good image quality). Mean heart rate during scan was 76 beats/min. Cross-sectional multiplanar reconstruction image from segment of stent with intimal hyperplasia shows neointimal hyperplasia as minimal low-attenuation filling defect (arrows) inside stent lumen.

 

Figure 9
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  		Fig. 3C —67-year-old man with minimal neointimal hyperplasia but no significant stenosis in stent in proximal segment of left anterior descending artery. Interval between stent placement and CT was 27 months. Patient was referred because of angina-like symptoms. He was current smoker with hypercholesterolemia. Image quality score is 1 (good image quality). Mean heart rate during scan was 76 beats/min. Right anterior oblique invasive coronary angiogram shows left anterior descending artery. Neointimal hyperplasia is evident as contour irregularity along stent lumen with no significant stenosis (arrow).

 

Figure 10
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  		Fig. 4A —62-year-old man with occlusion in stent in proximal segment of left anterior descending artery. Interval between stent placement and CT was 9 months. Patient was referred because of positive result of stress ECG test. Image quality score is 1 (good image quality). Mean heart rate during scan was 82 beats/min. Curved multiplanar reconstruction image shows complete loss of attenuation inside stent lumen (arrows) relative to stent occlusion.

 

Figure 11
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  		Fig. 4B —62-year-old man with occlusion in stent in proximal segment of left anterior descending artery. Interval between stent placement and CT was 9 months. Patient was referred because of positive result of stress ECG test. Image quality score is 1 (good image quality). Mean heart rate during scan was 82 beats/min. Cross-sectional multiplanar reconstruction images corresponding to segments of stent (arrows, A) show complete loss of attenuation inside stent lumen.

 

Figure 12
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  		Fig. 4C —62-year-old man with occlusion in stent in proximal segment of left anterior descending artery. Interval between stent placement and CT was 9 months. Patient was referred because of positive result of stress ECG test. Image quality score is 1 (good image quality). Mean heart rate during scan was 82 beats/min. Cross-sectional multiplanar reconstruction images corresponding to segments of stent (arrows, A) show complete loss of attenuation inside stent lumen.

 

Figure 13
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  		Fig. 4D —62-year-old man with occlusion in stent in proximal segment of left anterior descending artery. Interval between stent placement and CT was 9 months. Patient was referred because of positive result of stress ECG test. Image quality score is 1 (good image quality). Mean heart rate during scan was 82 beats/min. Right anterior oblique invasive coronary angiogram shows occlusion of stent. LAD = left anterior descending artery, LCX = left circumflex artery.

 

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