Coronary CT On Par with Invasive Tests for Absorb Stent Evaluation

3-year notes suggest ‘angelic’ exactness for restenosis detection

Objective Points

  • Noninvasive coronary CT angiography can ascertain restenosis in the Absorb bioresorbable vascular scaffold (BVS) with “commendable” exactness at 3 years post-implantation.
  • Note that the decipher suggests that that coronary CT angiography can be tatty in the clinical domestic to exclude in-scaffold restenosis and in the verification out setting to assess angiographic effects after BVS implantation.

Noninvasive coronary CT angiography can determine to be restenosis in the Absorb bioresorbable vascular scaffold (BVS) with “movables” correctness at 3 years post-implantation, an ABSORB II substudy played.

Coronary CT angiography desisted toe-to-toe with invasive coronary angiography when beared with intravascular ultrasound (IVUS) for the notice of obstructive lesions, with a precisely the same condition of underestimation of in-scaffold luminal diameters (10% and 16%, one at a time).

The noninvasive presentation underestimated slightest luminal diameter (MLD) by 0.14 mm on mean compared with the soupon of quantitative coronary angiography (QCA) and overestimated would-be luminal arrondissement (MLA) by 0.73 mm2 against IVUS, Patrick Serruys, MD, PhD, of Elegant College of London, and friends reported online in JACC: Cardiovascular Imaging.

The preciseness of coronary CT for copping stenosis on a scaffold-by-scaffold state was fairly decency whether it was delineated as QCA diameter stenosis ≥50% (AUC 0.88, 95% CI 0.82-0.92) or IVUS MLA ≤ 2.5 mm2 (AUC 0.83, 95% CI 0.77-0.88). Touchiness was 80% and 71%, and specificity 100% and 82%, each to each, Serruys’ aggregation reported.

“Coronary CT angiography has avail diagnostic Loosely nicety to detect in-scaffold luminal barrier and to assess luminal dimensions after BVS implantation,” Serruys’ cadre concluded. “This proclamation suggests that coronary CT angiography can be traditional in the clinical unnoticed to exclude in-scaffold restenosis and in the check into out setting to assess angiographic after-effects after BVS implantation.”

CT angiography has been articled to hold demean diagnostic proffering in patients with metallic stents than in those with de novo lesions, “at source due to the artifact arose by the metal in the coronary lumen,” the researchers famed.

But the polymer firmness of the Absorb BVS is radiolucent, allowing for coronary CT angiography without beam-hardening artifacts, the researchers creditable. Two radiopaque platinum markers of 244 μm — outstaying at each end of the scaffold — are perceivable on CT and other similarity modalities.

Serruys and chaps looked at Absorb BVS legatees in the ABSORB II tribulation who got QCA, coronary CT angiography, and/or IVUS 3 years after stenting. An undervaluing core lab realized data critique. Of 238 valetudinarians with 259 lesions filed in the analysis, at any rate, only 180 sufferers and 189 lesions had all three imaging evaluations functioned in the desire run.

That a table of patients were hectic to follow-up was one limitation to the substudy. Other limitations take away in a low restenosis angle (2.5% on QCA) that may buy played a rite in the good preciseness size up in the about, referral taint due to symptomatic long-sufferings being referred unambiguously to coronary angiography, insufficiency of serviceable assessment as clinical intimation, and comprehensive non-complex lesions in dataset.

Serruys’ viscosity chose the 3-year tendency for imaging for a soundness, suggested Joaquin Cigarroa, MD, of Oregon Weight & Sciences University in Portland, in an chaperoning essay. “By 3 to 5 years, the polymer should be returned by a de-novo connective crowd with associated repository remodeling.”

For all that, he wrote, “the use of coronary CT angiography at 3 years does not laud the fundamental incredible of determining the piquancy or absence of binary restenosis during the from the gen go 12 months when the varied than half of patients start out angiographic and clinical restenosis, a beforehand when the intestinal fortitude of the BVS with their associated smokier promenades (analogous to to everolimus-eluting [metallic] stents) and overwhelming mass are nearest.”

Cigarroa tinkled the conclusion that coronary CT angiography has high-minded diagnostic Loosely rigorousness to detect in-scaffold luminal obstruction “unfactual,” as most of scaffold is go past its prime by 3 years, he set. “Coronary CT angiography, in all actualities, at 3 years is an key tool to assess the level-headedness of a lesion and the remodeling associated with the ex BVS percutaneous coronary intervention.”

“To approach devote the suspect of diagnostic exactness of coronary CT angiography to learn of in-scaffold luminal bottleneck in patients medicated with BVS, one hankering have to act a comparison of coronary CT angiography and invasive coronary angiography at 6 to 12 months, a numerous clinically allied over and over again framing for our patients and our clinicians,” harmonizing to the editorialist.

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