Thallium-199 myocardial perfusion scintigraphy in the diagnosis of restenoses after balloon dilatation and stenting of the coronary arteries.
OBJECTIVE
To evaluate the diagnostic importance of thallium-199 myocardial perfusion single-photon emission computed tomography (SPECT) in the recognition of coronary restenoses and stenoses de novo of varying sites after endovascular treatment of coronary artery disease (CAD).


METHODS
Myocardial perfusion scintigraphy was used to examine forty-six patients presenting with CAD before, 2-3 weeks, 3-6 months and 1-2 years after balloon dilatation and/or stenting of the coronary arteries (CA). The presence, character and magnitude of perfusion defects were estimated.


RESULTS
The coronary angioplasty resulted in a 76% decrease of the mean size of transient ischemic zones. The reversible defects of thallium accumulation coexisted after operation with incomplete myocardial revasculization in patients with hemodynamically significant multivessel lesions. In the long-term follow up (3-6 months and 1-2 years after endovascular treatment), aggravation of coronary insufficiency in patients with incomplete revascularization proceeded mainly due to an increase in the size of the areas marked by persistent disturbance of coronary microcirculation determined not only by acute necrotic myocardial infarction but also by transformation of transient ischemic zones to the new stable perfusion defects. As compared to the early times, the patients with verified restenoses and stenoses de novo showed in the later period (3-6 months after coronary angioplasty) a significant increase in the mean size of the transient ischemic zones, exceeding the preoperative level. In six of the eleven patients, the appearance of the new stable defects was marked after 1-2 years in the area of blood supply to the recanalized CA. Meanwhile the condition of myocardial perfusion in the group of patients without restenoses did not undergo any noticeable changes.


CONCLUSIONS
Myocardial perfusion scintigraphy using thallium-199 chloride allows to objectively evaluate over time the results of endovascular treatment of CAD. Also, there is every probability of success of predicting restenoses and stenoses de novo.
Vesnina
Zh V
ZhV
Laboratory of Radionuclide Research Methods, Tomsk Scientific Center, Siberian Branch, Russian Academy of Medical Sciences, Tomsk, Russia. nuclear@cardio.tsu.ru
Rybalchenko
E V
EV
Krylov
A L
AL
Lishmanov
Iu B
IuB
D000789:Angina, Unstable / Q000628:therapy; D002404:Catheterization / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000628:therapy*; D009206:Myocardium / Q000378:metabolism*; D013794:Thallium Radioisotopes / Q000493:pharmacokinetics*; D014055:Tomography, Emission-Computed / Q000295:instrumentation*
D013794:Thallium Radioisotopes