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Coronary Arterial Stent Patency: Assessment with Electron-Beam CT¹

¹ From the Institute of Diagnostic and Interventional Radiology, University of Witten/Herdecke, Schulstr 10, 45468 Muelheim a. d. Ruhr, Germany (H.P., C.A.S., S.S.S., A.S., R.M.M.S.); the Department of Radiology and Microtherapy, University of Witten/Herdecke, Bochum, Germany (S.M., D.H.W.G.); and the Department of Cardiology, University of Essen, Germany (S.M., R.E.). From the 1997 RSNA scientific assembly. Received July 21, 1997; revision requested October 7; final revision received April 26, 1999; accepted August 20. Address reprint requests to H.P. (e-mail: pump@mri.de).

View larger version (142K): [in a new window]   Figure 1a. (a) Transverse electron-beam CT scan obtained in a 60-year-old man shows a Micro-stent (straight arrow) in the proximal region of the left anterior descending artery (curved arrow). Calcified plaques in the left main coronary artery (arrowhead) also are seen. (b) Coronary angiogram obtained in the same patient as in a shows the stent (arrow).

View larger version (121K): [in a new window]   Figure 1b. (a) Transverse electron-beam CT scan obtained in a 60-year-old man shows a Micro-stent (straight arrow) in the proximal region of the left anterior descending artery (curved arrow). Calcified plaques in the left main coronary artery (arrowhead) also are seen. (b) Coronary angiogram obtained in the same patient as in a shows the stent (arrow).

View larger version (98K): [in a new window]   Figure 2a. (a) Right anterior oblique coronary angiogram obtained in a 59-year-old man shows a patent stent in the left anterior descending artery. The arrows indicate the end of the Powergrip stent (Cordis). (b) Transverse CT scan (multisection mode) obtained in the same patient as in a shows the patent stent (arrows). A time-attenuation measurement was obtained proximal to the stent (B). (c) Graph that corresponds with b illustrates a comparison of the deposited regions of interest. The gamma variate curve of the left anterior descending artery proximal to the stent (B) is compared with the aortic curve (A). The mean transit time in the aorta was 8.08 seconds; that in the proximal left anterior descending artery was 8.61 seconds. The peak enhancement time in the aorta was 6.5 seconds; that in the proximal left anterior descending artery was 6.6 seconds. (d) On another transverse CT scan (multisection mode) obtained in the same patient as in a and b, the region of interest (ROI) distal to the stent (B) is seen. LAD = left anterior descending artery. (e) Time-attenuation measurement graph that corresponds with d. The gamma variate curve distal to the patent stent (B) is compared with the aortic curve (A). The mean transit time in the left anterior descending artery was 10.01 seconds, and the peak enhancement time was 7.8 seconds.

View larger version (94K): [in a new window]   Figure 2b. (a) Right anterior oblique coronary angiogram obtained in a 59-year-old man shows a patent stent in the left anterior descending artery. The arrows indicate the end of the Powergrip stent (Cordis). (b) Transverse CT scan (multisection mode) obtained in the same patient as in a shows the patent stent (arrows). A time-attenuation measurement was obtained proximal to the stent (B). (c) Graph that corresponds with b illustrates a comparison of the deposited regions of interest. The gamma variate curve of the left anterior descending artery proximal to the stent (B) is compared with the aortic curve (A). The mean transit time in the aorta was 8.08 seconds; that in the proximal left anterior descending artery was 8.61 seconds. The peak enhancement time in the aorta was 6.5 seconds; that in the proximal left anterior descending artery was 6.6 seconds. (d) On another transverse CT scan (multisection mode) obtained in the same patient as in a and b, the region of interest (ROI) distal to the stent (B) is seen. LAD = left anterior descending artery. (e) Time-attenuation measurement graph that corresponds with d. The gamma variate curve distal to the patent stent (B) is compared with the aortic curve (A). The mean transit time in the left anterior descending artery was 10.01 seconds, and the peak enhancement time was 7.8 seconds.

View larger version (12K): [in a new window]   Figure 2c. (a) Right anterior oblique coronary angiogram obtained in a 59-year-old man shows a patent stent in the left anterior descending artery. The arrows indicate the end of the Powergrip stent (Cordis). (b) Transverse CT scan (multisection mode) obtained in the same patient as in a shows the patent stent (arrows). A time-attenuation measurement was obtained proximal to the stent (B). (c) Graph that corresponds with b illustrates a comparison of the deposited regions of interest. The gamma variate curve of the left anterior descending artery proximal to the stent (B) is compared with the aortic curve (A). The mean transit time in the aorta was 8.08 seconds; that in the proximal left anterior descending artery was 8.61 seconds. The peak enhancement time in the aorta was 6.5 seconds; that in the proximal left anterior descending artery was 6.6 seconds. (d) On another transverse CT scan (multisection mode) obtained in the same patient as in a and b, the region of interest (ROI) distal to the stent (B) is seen. LAD = left anterior descending artery. (e) Time-attenuation measurement graph that corresponds with d. The gamma variate curve distal to the patent stent (B) is compared with the aortic curve (A). The mean transit time in the left anterior descending artery was 10.01 seconds, and the peak enhancement time was 7.8 seconds.

View larger version (121K): [in a new window]   Figure 2d. (a) Right anterior oblique coronary angiogram obtained in a 59-year-old man shows a patent stent in the left anterior descending artery. The arrows indicate the end of the Powergrip stent (Cordis). (b) Transverse CT scan (multisection mode) obtained in the same patient as in a shows the patent stent (arrows). A time-attenuation measurement was obtained proximal to the stent (B). (c) Graph that corresponds with b illustrates a comparison of the deposited regions of interest. The gamma variate curve of the left anterior descending artery proximal to the stent (B) is compared with the aortic curve (A). The mean transit time in the aorta was 8.08 seconds; that in the proximal left anterior descending artery was 8.61 seconds. The peak enhancement time in the aorta was 6.5 seconds; that in the proximal left anterior descending artery was 6.6 seconds. (d) On another transverse CT scan (multisection mode) obtained in the same patient as in a and b, the region of interest (ROI) distal to the stent (B) is seen. LAD = left anterior descending artery. (e) Time-attenuation measurement graph that corresponds with d. The gamma variate curve distal to the patent stent (B) is compared with the aortic curve (A). The mean transit time in the left anterior descending artery was 10.01 seconds, and the peak enhancement time was 7.8 seconds.

View larger version (12K): [in a new window]   Figure 2e. (a) Right anterior oblique coronary angiogram obtained in a 59-year-old man shows a patent stent in the left anterior descending artery. The arrows indicate the end of the Powergrip stent (Cordis). (b) Transverse CT scan (multisection mode) obtained in the same patient as in a shows the patent stent (arrows). A time-attenuation measurement was obtained proximal to the stent (B). (c) Graph that corresponds with b illustrates a comparison of the deposited regions of interest. The gamma variate curve of the left anterior descending artery proximal to the stent (B) is compared with the aortic curve (A). The mean transit time in the aorta was 8.08 seconds; that in the proximal left anterior descending artery was 8.61 seconds. The peak enhancement time in the aorta was 6.5 seconds; that in the proximal left anterior descending artery was 6.6 seconds. (d) On another transverse CT scan (multisection mode) obtained in the same patient as in a and b, the region of interest (ROI) distal to the stent (B) is seen. LAD = left anterior descending artery. (e) Time-attenuation measurement graph that corresponds with d. The gamma variate curve distal to the patent stent (B) is compared with the aortic curve (A). The mean transit time in the left anterior descending artery was 10.01 seconds, and the peak enhancement time was 7.8 seconds.

View larger version (141K): [in a new window]   Figure 3a. (a) Transverse CT scan (multisection mode) obtained in a 63-year-old man shows a high-grade left anterior descending arterial stenosis distal to the stent. The region of interest is placed in a hypoattenuating distal vessel region (arrow). (b) Time-attenuation measurement graph that corresponds with a. The unconnected dots below the 100-HU mark (B) indicate the region of interest placed in the hypoattenuating distal vessel region. A = gamma variate curve of the ascending aorta.

View larger version (11K): [in a new window]   Figure 3b. (a) Transverse CT scan (multisection mode) obtained in a 63-year-old man shows a high-grade left anterior descending arterial stenosis distal to the stent. The region of interest is placed in a hypoattenuating distal vessel region (arrow). (b) Time-attenuation measurement graph that corresponds with a. The unconnected dots below the 100-HU mark (B) indicate the region of interest placed in the hypoattenuating distal vessel region. A = gamma variate curve of the ascending aorta.

View larger version (79K): [in a new window]   Figure 4. Curved multiplanar electron-beam CT reconstruction of a patent left anterior descending arterial stent (straight arrow) in a 53-year-old man. The vessel region distal to the stent is hyperattenuating. The left main coronary artery (curved arrow) and left anterior descending artery (arrowhead) are seen.