CLINICAL RESEARCH: CARDIAC IMAGING AND STENT FAILURE
Stent Gap by 64-Detector Computed Tomographic AngiographyRelationship to In-Stent Restenosis, Fracture, and Overlap Failure
Harvey S. Hecht, MD*,
Sotir Polena, MD,
Vladimir Jelnin, MD,
Marcelo Jimenez, MD,
Tandeep Bhatti, DO,
Manish Parikh, MD,
Georgia Panagopoulos, PhD and
Gary Roubin, MD, PhD
Lenox Hill Heart & Vascular Institute, New York, New York
Manuscript received April 15, 2009;
revised manuscript received May 29, 2009,
accepted June 2, 2009.
* Address for correspondence: Dr. Harvey S. Hecht, Lenox Hill Heart and Vascular Institute, 130 East 77th Street, New York, New York 10021 (Email: hhecht{at}aol.com).
Objectives: The goal of this study was to define the frequency of stent gaps by 64-detector computed tomographic angiography (CTA) and their relation to in-stent restenosis (ISR), stent fracture (SF), and overlap failure (OF).
Background: SF defined by catheter angiography or intravascular ultrasound has been implicated in ISR.
Methods: A total of 292 consecutive patients, with 613 stents, who underwent CTA were evaluated for stent gaps associated with decreased Hounsfield units. Correlations with catheter coronary angiography (CCA) were available in 143 patients with 384 stents.
Results: Stent gaps were noted in 16.9% by CTA and 1.0% by CCA. ISR by CCA was noted in 46.1% of the stent gaps (p < 0.001) as determined by CCA, and stent gaps by CTA accounted for 27.8% of the total ISR (p < 0.001). In univariate analysis, stent diameter  3 mm was the only CCA characteristic significantly associated with stent gaps (p = 0.002), but was not a significant predictor by multivariate analysis. Bifurcation stents, underlying calcification, stent type, location, post-dilation, and overlapping stents were not observed to be predisposing factors. Excessive tortuosity and lack of conformability were not associated with stent gaps; however, their frequency was insufficient to permit meaningful analysis.
Conclusions: Stent gap by CTA: 1) is associated with 28% of ISR, and ISR is found in 46% of stent gaps; 2) is associated with 3-mm stents by univariate (p = 0.002) but not by multivariate analysis; 3) is infrequently noted on catheter angiography; and 4) most likely represents SF in the setting of a single stent, and may represent SF or OF in overlapping stents.
Key Words: stent fracture • stent gap • overlap failure • in-stent restenosis • computed tomographic angiography
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Abbreviations and Acronyms
| | CCA = catheter coronary angiography | | CTA = computed tomographic angiography | | HU = Hounsfield unit | | ISR = in-stent restenosis | | IVUS = intravascular ultrasound | | OF = overlap failure | | SF = stent fracture |
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J. Am. Coll. Cardiol. 2009 54: A32.
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