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Journal of Clinical Cardiology

ISSN: 2694-5088

Original Research Open Access

Coronary CT Angiography and Assessment of Coronary In-Stent Restenosis—A Brief Report of Stent-Related Factors among Positive Angiographic Cases

Ramin Khameneh Bagheri1, Mahdi Radfar1,*, Hassan Mehrad-Majd2, Ali Heydari Bakavoli 1
  • 1Cardiovascular Research Center, Mashhad University of Medical Sciences, Iran
  • 2Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
+ Affiliations - Affiliations

Corresponding Author

Mahdi Radfar, mahdiradfar95@gmail.com

Received Date: April 11, 2025

Accepted Date: June 22, 2025

Citation:

Khameneh-Bagheri R, Radfar M, Mehrad-Majd H, Bakavoli AH. Coronary CT Angiography and Assessment of Coronary In-Stent Restenosis—A Brief Report of Stent-Related Factors among Positive Angiographic Cases. J Clin Cardiol. 2025;6(2):91–96.


Copyright: © 2025 Khameneh-Bagheri R, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background: In-stent restenosis (ISR) remains a significant concern in coronary artery disease management. This study aims to evaluate the efficacy of coronary computed tomography angiography (CCTA) in detecting ISR and to identify stent-related factors in a real-world patient population.

Methods: This single-center study was conducted over a six-month period in 2024. Patients with a history of PCI who underwent CCTA due to suspected ISR were included, with subsequent invasive coronary angiography (ICA) performed for confirmation. One randomly experienced radiologist evaluated CCTA images for stent characteristics and ISR severity, while two interventional cardiologists assessed ICA results. The association between CCTA findings related to stents and ISR confirmation via ICA was analyzed, and the positive predictive value (PPV) for CCTA in identifying significant ISR was calculated.

Results: A total of 22 patients were included in the study, with a mean age of 62.5 ± 7.3 years. A total of 34 stents were evaluated by CCTA, revealing that 7 stents (20.6%) exhibited ISR with <50% stenosis, while 27 stents (79.4%) had >50% stenosis. The presence of >50% stenosis was statistically significant (p=0.026) associated with ICA findings, with a PPV of 51.8%. Notable variations in PPV were observed based on stent location: proximal left anterior descending artery (LAD) placements had a PPV of 60%, while mid-LAD placements had a PPV of 57.1%. Stents longer than 30 mm demonstrated a higher likelihood of >50% ISR (p=0.011), with a PPV of 76.9%, compared to those measuring 10-20 mm (40%). Additionally, stent diameter was significantly associated with ISR on ICA findings (p=0.024), where larger diameters (>3.5 mm) exhibited an 85.7% PPV for >50% ISR.

Conclusion: Coronary CT angiography serves as an important method for evaluating in-stent restenosis, though its predictive accuracy can differ based on several factors. As a result, is essential to take into account the stent's location within the coronary vessels, as well as its length and diameter. This consideration may assist healthcare professionals in making informed clinical decisions and developing follow-up plans for managing coronary artery disease.

Keywords

In-stent restenosis, Coronary computed tomography angiography, Coronary artery disease, Stent, Positive predictive value, Diagnostic tool

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