INTRODUCTION: The aim of this prospective study was to evaluate the diagnostic accuracy of dual-source computed tomography coronary angiography (CTCA) compared to intravascular ultrasound (IVUS) for the detection of restenosis in patients who underwent coronary stenting for bifurcation left main (LM) stenosis. MATERIAL AND METHODS: Twenty-four patients underwent percutaneous intervention of the LM and were subsequently examined (median 9.2 months after procedure) using IVUS and CTCA for the detection of restenosis. RESULTS: Significant restenosis was detected according to IVUS examination in 6 patients (25%) and 8 segments (13%). Based on segment analysis, sensitivity, specificity, positive and negative predictive values of CTCA for the detection of restenosis were 89%, 68%, 32%, 97%, respectively. There was moderate to good correlation between the minimal luminal area (MLA), measured by CTCA and IVUS for LM, the left anterior descending artery (LAD) and the left circumflex artery (LCx) (r=0.64, p<0.01; r=0.49, p=0.03; r=0.76, p<0.01, respectively). A Bland-Altman analysis showed that the MLAs measured by CTCA were underestimated in all segments (mean difference 1.67 ±2.2 mm(2) for LM; 2.0 ±2.0 mm(2) for LAD; 1.79 ±1.79 mm(2) for LCx). An ROC analysis of the MLAs derived by CTCA for detecting significant stenosis was performed. The area under the curve for all analysed segments was 0.73. CONCLUSIONS: The present study demonstrates that in patients after LM bifurcation stenting CTCA performs well in the exclusion of in-segment restenosis. However, due to the low positive predictive value of CTCA, the finding of any restenosis should be confirmed by invasive examination.

Department of Cardiology 2 Medical School Charles University University Hospital Motol Prague Czech Republic

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Wijns W, Kolh P, Danchin N, et al. Guidelines on myocardial revascularization. Eur Heart J. 2010;31:2501–55. PubMed

Park DW, Kim YH, Yun SC, et al. Long-term outcomes after stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: 10-year results of bare-metal stents and 5-year results of drug-eluting stents from the ASAN-MAIN (ASAN Medical Center-Left MAIN Revascularization) Registry. J Am Coll Cardiol. 2010;56:1366–75. PubMed

Park SJ, Kim YH. Percutaneous coronary intervention for unprotected left main coronary artery stenosis. World J Cardiol. 2010;2:78–88. PubMed PMC

Chieffo A, Park SJ, Valgimigli M, et al. Favorable long-term outcome after drug-eluting stent implantation in nonbifurcation lesions that involve unprotected left main coronary artery: a multicenter registry. Circulation. 2007;116:158–62. PubMed

Valgimigli M, Malagutti P, Rodriguez-Granillo GA, et al. Distal left main coronary disease is a major predictor of outcome in patients undergoing percutaneous intervention in the drug-eluting stent era: an integrated clinical and angiographic analysis based on the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) and Taxus-Stent Evaluated At Rotterdam Cardiology Hospital (T-SEARCH) registries. J Am Coll Cardiol. 2006;47:1530–7. PubMed

Biondi-Zoccai GG, Giraudi E, Moretti C, et al. Impact of routine angiographic follow-up after percutaneous coronary drug-eluting stenting for unprotected left main disease: the Turin Registry. Clin Res Cardiol. 2010;99:235–42. PubMed

Pugliese F, Weustink AC, Van Mieghem C, et al. Dual source coronary computed tomography angiography for detecting in-stent restenosis. Heart. 2008;94:848–54. PubMed

Carrabba N, Bamoshmoosh M, Carusi LM, et al. Usefulness of 64-slice multidetector computed tomography for detecting drug eluting in-stent restenosis. Am J Cardiol. 2007;100:1754–8. PubMed

Andreini D, Pontone G, Bartorelli AL, et al. Comparison of feasibility and diagnostic accuracy of 64-slice multidetector computed tomographic coronary angiography versus invasive coronary angiography versus intravascular ultrasound for evaluation of in-stent restenosis. Am J Cardiol. 2009;103:1349–58. PubMed

Gilard M, Cornily JC, Rioufol G, et al. Noninvasive assessment of left main coronary stent patency with 16-slice computed tomography. Am J Cardiol. 2005;95:110–12. PubMed

Veselka J, Mates M, Tesař D, et al. Direct stenting without predilatation: a new approach to coronary intervention. Coron Artery Dis. 2000;11:503–7. PubMed

Medina A, Suárez de Lezo J, Pan M. A new classification of coronary bifurcation lesions. Rev Esp Cardiol. 2006;59:183. PubMed

Veselka J, Zemánek D, Duchoňová R, et al. Coronary angiography and dual-source computed tomography are complementary methods in diagnosis of significant stenosis of the right coronary artery originating from the left aortic sinus. Cent Eur J Med. 2008;3:111–4.

Cervinka P, Costa MA, Angiolillo DJ, et al. Head-to-head comparison between sirolimus-eluting and paclitaxel-eluting stents in patients with complex coronary artery disease: an intravascular ultrasound study”. Catheter Cardiovasc Interv. 2006;67:846–51. PubMed

Shao JH, Aronow WS, Ravipati G, et al. Prevalence of minimal luminal cross sectional area of coronary arteries < 4 mm2 determined by intravascular ultrasound in patients with coronary artery calcium scores of 0-100, 100-200, 200-300, and > 400 determined by cardiac computed tomography. Arch Med Sci. 2009;5:172–4.

Taylor AJ, Cerqueira M, Hodgson JM, et al. ACCF/SCCT/ ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2010;56:1864–94. PubMed

Oviedo C, Maehara A, Mintz GS, et al. Intravascular ultrasound classification of plaque distribution in left main coronary artery bifurcations: where is the plaque really located? Circ Cardiovasc Interv. 2010;3:105–12. PubMed

Dragu R, Kerner A, Gruberg L, et al. Angiographically uncertain left main coronary artery narrowings: correlation with multidetector computed tomography and intravascular ultrasound. Int J Cardiovasc Imag. 2008;24:557–63. PubMed

Sun Z, Almutairi AM. 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. PubMed

Maintz D, Burg MC, Seifarth H, et al. Update on multidetector coronary CT angiography of coronary stents: in vitro evaluation of 29 different stent types with dual-source CT. Eur Radiol. 2009;19:42–9. PubMed

Wu W, Petrini L, Gastaldi D, et al. Finite element shape optimization for biodegradable magnesium alloy stents. Ann Biomed Eng. 2010;38:2829–40. PubMed

Colombo A, Moses JW, Morice MC, et al. Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions. Circulation. 2004;109:1244–49. PubMed

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