Non-invasive diagnosis of in stent stenosis by stress 99m technetium tetrofosmin myocardial perfusion imaging.
BACKGROUND
The aim of this study was to assess the accuracy of stress 99m technetium tetrofosmin myocardial perfusion imaging for the diagnosis of in stent stenosis (ISS).


METHODS
We studied 72 patients who underwent exercise or dobutamine stress 99m technetium tetrofosmin imaging, 0.9+/-0.5 years after percutaneous coronary interventions in which stents were deployed. Coronary angiography was performed within 3 months of the stress test. ISS was defined as > or =50% stenosis in a coronary segment with previous stenting. Significant coronary artery disease (CAD) was defined as > or =50% stenosis within or outside the stented coronary segment.


RESULTS
The stent was deployed in 1 coronary artery in 52 patients, and in 2 coronary arteries in 20 patients (a total of 92 detected in 42 (58%) patients (51 stents). Reversible perfusion abnormalities were present in 34 of patients with ISS (sensitivity=81%, CI 70-94). Regional sensitivity for diagnosis of stenosis per stent was 76% (CI 65-88), specificity was 83% (CI 71-94) and accuracy was 79% (CI 69-85). Reversible perfusion abnormalities were detected in > or =2 vascular distributions in 15 of 22 patients with multi-vessel CAD and in 5 of 50 patients without (sensitivity for identifying multivessel CAD=68%, CI 50-89; specificity=90%, CI 82-98; and accuracy=83%, CI 75-90).


CONCLUSIONS
Stress 99m technetium tetrofosmin myocardial perfusion imaging is a useful non-invasive technique for the diagnosis of in stent stenosis and extent of CAD in patients with previous percutaneous coronary artery interventions.
Elhendy
Abdou
A
Thoraxcenter, University Hospital Rotterdam, Rotterdam, The Netherlands. Aelhendy@unmc.edu
Schinkel
Arend F L
AF
van Domberg
Ron T
RT
Bax
Jeroen J
JJ
Valkema
Roelf
R
Poldermans
Don
D
D000318:Adrenergic beta-Agonists; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D003326:Coronary Circulation; D023903:Coronary Restenosis / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D004280:Dobutamine; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012107:Research Design; D012680:Sensitivity and Specificity; D015607:Stents; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
D000318:Adrenergic beta-Agonists; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D004280:Dobutamine; C078700:technetium tc-99m tetrofosmin