Top

The International Journal of Cardiovascular Imaging

Published in:

01-12-2012 | Original Paper

Diagnostic value of myocardial SPECT to detect in-stent restenosis after drug-eluting stent implantation

Authors: Hyo Eun Park, Bon-Kwon Koo, Kyung-Woo Park, Jin Chul Paeng, Hae-Young Lee, Hyun-Jae Kang, Hyo-Soo Kim

Published in: The International Journal of Cardiovascular Imaging | Issue 8/2012

Abstract

Different angiographic patterns and restenosis rate may affect diagnostic value of single-photon emission computed tomography (SPECT) in the era of drug-eluting stents (DES). We aimed to determine the ability of myocardial SPECT to detect in-stent restenosis (ISR) in patients treated with DES compared to that of patients treated with bare metal stent (BMS). We evaluated 228 consecutive patients who underwent 6 months follow-up SPECT and coronary angiography (CAG) after stent implantation. In 228 patients, 354 vessels were treated with stent implantation (BMS, n = 105; DES, n = 249) and 65 (18.4%) vessels showed ISR (angiographic % diameter stenosis ≥50%) at the 6-month follow-up CAG. In patients with BMS-ISR (n = 37), restenosis was primarily diffuse (70.3%), whereas patients with DES-ISR (n = 28) exhibited more focal restenosis (53.6%, p = 0.028). The sensitivity and specificity of myocardial SPECT did not differ significantly between patients with BMS and those with DES (BMS vs. DES: sensitivity 56.8 vs. 39.3%, p = 0.163; specificity 72.1 vs. 76.5%, p = 0.460). Evaluation of 71 false positive and 33 false negative lesions showed that the most common cause of false-positive results in SPECT was the perfusion decrease which improved but not disappeared compared with the baseline (46 among 71 vascular territories). Despite different patterns of restenosis and ISR rates, the diagnostic value of SPECT did not differ between BMS and DES. Further study looking at ISR in larger number of patients and using other protocol such as Fleming-Harrington Redistribution Wash-in Washout may give additional information.

Ruygrok PN, Webster MW, de Valk V, van Es GA, Ormiston JA, Morel MA, Serruys PW (2001) Clinical and angiographic factors associated with asymptomatic restenosis after percutaneous coronary intervention. Circulation 104:2289–2294PubMedCrossRef

Holmes DR Jr, Vlietstra RE, Smith HC, Vetrovec GW, Kent KM, Cowley MJ, Faxon DP, Gruentzig AR, Kelsey SF, Detre KM, van Raden MJ, Mock MB (1984) Restenosis after percutaneous transluminal coronary angioplasty (PTCA): a report from the PTCA Registry of the National Heart, Lung, and Blood Institute. Am J Cardiol 53:77C–81CPubMedCrossRef

Pfisterer M, Rickenbacher P, Kiowski W, Muller-Brand J, Burkart F (1993) Silent ischemia after percutaneous transluminal coronary angioplasty: incidence and prognostic significance. J Am Coll Cardiol 22:1446–1454PubMedCrossRef

Hernandez RA, Macaya C, Iniguez A, Alfonso F, Goicolea J, Fernandez-Ortiz A, Zarco P (1992) Midterm outcome of patients with asymptomatic restenosis after coronary balloon angioplasty. J Am Coll Cardiol 19:1402–1409PubMedCrossRef

Zellweger MJ, Weinbacher M, Zutter AW, Jeger RV, Muller-Brand J, Kaiser C, Buser PT, Pfisterer ME (2003) Long-term outcome of patients with silent versus symptomatic ischemia six months after percutaneous coronary intervention and stenting. J Am Coll Cardiol 42:33–40PubMedCrossRef

Giedd KN, Bergmann SR (2004) Myocardial perfusion imaging following percutaneous coronary intervention: the importance of restenosis, disease progression, and directed reintervention. J Am Coll Cardiol 43:328–336PubMedCrossRef

Bergmann SR, Giedd KN (2003) Silent ischemia: unsafe at any time. J Am Coll Cardiol 42:41–44PubMedCrossRef

Steinberg DH, Gaglia MA Jr, Pinto Slottow TL, Roy P, Bonello L, De Labriolle A, Lemesle G, Torguson R, Kineshige K, Xue Z, Suddath WO, Kent KM, Satler LF, Pichard AD, Lindsay J, Waksman R (2009) Outcome differences with the use of drug-eluting stents for the treatment of in-stent restenosis of bare-metal stents versus drug-eluting stents. Am J Cardiol 103:491–495PubMedCrossRef

Mehran R, Dangas G, Abizaid AS, Mintz GS, Lansky AJ, Satler LF, Pichard AD, Kent KM, Stone GW, Leon MB (1999) Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome. Circulation 100:1872–1878PubMedCrossRef

10.

Emmett L, Iwanochko RM, Freeman MR, Barolet A, Lee DS, Husain M (2002) Reversible regional wall motion abnormalities on exercise technetium-99 m-gated cardiac single photon emission computed tomography predict high-grade angiographic stenoses. J Am Coll Cardiol 39:991–998PubMedCrossRef

11.

Kim DW, Park SA, Kim CG, Lee C, Oh SK, Jeong JW (2008) Reversible defects on myocardial perfusion imaging early after coronary stent implantation: a predictor of late restenosis. Int J Cardiovasc Imaging 24:503–510PubMedCrossRef

12.

Gimelli A, Rossi G, Landi P, Marzullo P, Lervasi G, L’Abbate A, Rovai D (2009) Stress/rest myocardial perfusion abnormalities by gated SPECT: Still the best predictor of cardiac events in stable ischemic heart disease. J Nucl Med 50:546–553PubMedCrossRef

13.

Lee KL, Pryor DB, Pieper KS, Harrell FE, Califf RM, Mark DB, Hlatky MA, Coleman RE, Cobb FR, Jones RH (1990) Prognostic value of radionuclide angiography in medically treated patients with coronary artery disease. A comparison with clinical and catheterization variables. Circulation 82:1705–1717PubMedCrossRef

14.

Cottin Y, Rezaizadeh K, Touzery C, Barillot I, Zeller M, Prevot S, L’Huillier I, Ressencourt O, Andre F, Fraison M, Louis P, Brunotte F, Wolf JE (2001) Long-term prognostic value of 201Tl single-photon emission computed tomographic myocardial perfusion imaging after coronary stenting. Am Heart J 141:999–1006PubMedCrossRef

15.

Kosa I, Blasini R, Schneider-Eicke J, Neumann FJ, Matsunari I, Neverve J, Schomig A, Schwaiger M (1998) Myocardial perfusion scintigraphy to evaluate patients after coronary stent implantation. J Nucl Med 39:1307–1311PubMed

16.

Mowatt G, Vale L, Brazzelli M, Hernandez R, Murray A, Scott N, Schomig A, Schwaiger M (2004) Systematic review of the effectiveness and cost-effectiveness, and economic evaluation, of myocardial perfusion scintigraphy for the diagnosis and management of angina and myocardial infarction. Health Technol Assess 8:iii–iv, 1–207

17.

Sugiyama S, Hirota H, Yoshida M, Takemura Y, Nakaoka Y, Oshima Y, Terai K, Izumi M, Fujio Y, Hasegawa S, Mano T, Nakatsuchi Y, Hori M, Yamauchi-Takihara K, Kawase I (2004) Novel insertional mutation in the bone morphogenetic protein receptor type II associated with sporadic primary pulmonary hypertension. Circ J 68:592–594PubMedCrossRef

18.

Georgoulias P, Demakopoulos N, Kontos A, Xaplanteris P, Thomadakis K, Mortzos G, Karkavitsas N (1998) Tc-99 m tetrofosmin myocardial perfusion imaging before and six months after percutaneous transluminal coronary angioplasty. Clin Nucl Med 23:678–682PubMedCrossRef

19.

Galassi AR, Foti R, Azzarelli S, Coco G, Condorelli G, Russo G, Musumeci S, Tamburino C, Giuffrida G (2000) Usefulness of exercise tomographic myocardial perfusion imaging for detection of restenosis after coronary stent implantation. Am J Cardiol 85:1362–1364PubMedCrossRef

20.

Marie PY, Danchin N, Karcher G, Grentzinger A, Juilliere Y, Olivier P, Buffet P, Anconina J, Beurrier D, Cherrier F, Bertrand A (1993) Usefulness of exercise SPECT-thallium to detect asymptomatic restenosis in patients who had angina before coronary angioplasty. Am Heart J 126:571–577PubMedCrossRef

21.

Beygui F, Le Feuvre C, Maunoury C, Helft G, Antonietti T, Metzger JP, Vacheron A (2000) Detection of coronary restenosis by exercise electrocardiography thallium-201 perfusion imaging and coronary angiography in asymptomatic patients after percutaneous transluminal coronary angioplasty. Am J Cardiol 86:35–40PubMedCrossRef

22.

Isaaz K, Afif Z, Prevot N, Cerisier A, Lamaud M, Richard L, Faure E, Granjon D, Robin C, Hassan MS, Da Costa A, Dubois F (2008) The value of stress single-photon emission computed tomography imaging performed routinely at 6 months in asymptomatic patients for predicting angiographic restenosis after successful direct percutaneous intervention for acute ST elevation myocardial infarction. Coron Artery Dis 19:89–97PubMedCrossRef

23.

Sugi T, Satoh H, Uehara A, Katoh H, Terada H, Matsunaga M, Yamazaki K, Matoh F, Nakano T, Yoshihara S, Kurata C, Miyata H, Ukigai H, Tawarahara K, Kimura M, Suzuki S, Hayashi H (2004) Usefulness of stress myocardial perfusion imaging for evaluating asymptomatic patients after coronary stent implantation. Circ J 68:462–466PubMedCrossRef

24.

Melikian N, De Bondt P, Tonino P, De Winter O, Wyffels E, Bartunek J, Heyndrickx GR, Fearon WF, Pijls NH, Wijns W, De Bruyne B (2010) Fractional flow reserve and myocardial perfusion imaging in patients with angiographic multivessel coronary artery disease. JACC Cardiovasc Interv 3:307–314PubMedCrossRef

25.

Morice MC, Serruys PW, Sousa JE, Fajadet J, Ban Hayashi E, Perin M, Colombo A, Schuler G, Barragan P, Guagliumi G, Molnar F, Falotico R (2002) A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med 346:1773–1780PubMedCrossRef

26.

Ueda Y, Nanto S, Komamura K, Kodama K (1994) Neointimal coverage of stents in human coronary arteries observed by angioscopy. J Am Coll Cardiol 23:341–346PubMedCrossRef

27.

Oyabu J, Ueda Y, Ogasawara N, Okada K, Hirayama A, Kodama K (2006) Angioscopic evaluation of neointima coverage: sirolimus drug-eluting stent versus bare metal stent. Am Heart J 152:1168–1174PubMedCrossRef

28.

Garzon PP, Eisenberg MJ (2001) Functional testing for the detection of restenosis after percutaneous transluminal coronary angioplasty: a meta-analysis. Can J Cardiol 17:41–48

29.

Breisblatt WM, Barnes JV, Weiland F, Spaccavento LJ (1988) Incomplete revascularization in multivessel percutaneous transluminal coronary angioplasty: the role for stress thallium-201 imaging. J Am Coll Cardiol 11:1183–1190PubMedCrossRef

30.

Manyari DE, Knudtson M, Kloiber R, Roth D (1988) Sequential thallium-201 myocardial perfusion studies after successful percutaneous transluminal coronary artery angioplasty: delayed resolution of exercise-induced scintigraphic abnormalities. Circulation 77:86–95PubMedCrossRef

31.

Kern MJ, Puri S, Bach RG, Donohue TJ, Dupouy P, Caracciolo EA, Craig WR, Aguirre F, Aptecar E, Wolford TL, Mechem CJ, Dubois-Rande JL (1999) Abnormal coronary flow velocity reserve after coronary artery stenting in patients: role of relative coronary reserve to assess potential mechanisms. Circulation 100:2491–2498PubMedCrossRef

32.

van Beusekom HM, Whelan DM, Hofma SH, Krabbendam SC, van Hinsbergh VW, Verdouw PD, van der Giessen WJ (1998) Long-term endothelial dysfunction is more pronounced after stenting than after balloon angioplasty in porcine coronary arteries. J Am Coll Cardiol 32:1109–1117PubMedCrossRef

33.

Kalbfleisch H, Hort W (1977) Quantitative study on the size of coronary artery supplying areas postmortem. Am Heart J 94:183–188PubMedCrossRef

34.

Miller DD (2002) Coronary flow studies for risk stratification in multivessel disease. A physiologic bridge too far? J Am Coll Cardiol 39:859–863PubMedCrossRef

35.

Chamuleau SA, Meuwissen M, Koch KT, van Eck-Smit BL, Tio RA, Tijssen JG, Piek JJ (2002) Usefulness of fractional flow reserve for risk stratification of patients with multivessel coronary artery disease and an intermediate stenosis. Am J Cardiol 89:377–380PubMedCrossRef

36.

Christian TF, Miller TD, Bailey KR, Gibbons RJ (1992) Noninvasive identification of severe coronary artery disease using exercise tomographic thallium-201 imaging. Am J Cardiol 70:14–20PubMedCrossRef

37.

Ragosta M, Bishop AH, Lipson LC, Watson DD, Gimple LW, Sarembock IJ, Powers ER (2007) Comparison between angiography and fractional flow reserve versus single-photon emission computed tomographic myocardial perfusion imaging for determining lesion significance in patients with multivessel coronary disease. Am J Cardiol 99:896–902PubMedCrossRef

38.

Hirzel HO, Nuesch K, Gruentzig AR, Luetolf UM (1981) Short- and long-term changes in myocardial perfusion after percutaneous transluminal coronary angioplasty assessed by thallium-201 exercise scintigraphy. Circulation 63:1001–1007PubMedCrossRef

39.

Burrell S, MacDonald A (2006) Artifacts and pitfalls in myocardial perfusion imaging. J Nucl Med Technol 34:193–211; quiz 212–214

40.

Williams KA, Hill KA, Sheridan CM (2003) Noncardiac findings on dual-isotope myocardial perfusion SPECT. J Nucl Cardiol 10:395–402PubMedCrossRef

41.

Wheat JM, Currie GM (2004) Impact of patient motion on myocardial perfusion SPECT diagnostic integrity: part 2. J Nucl Med Technol 32:158–163PubMed

42.

Germano G, Chua T, Kiat H, Areeda JS, Berman DS (1994) A quantitative phantom analysis of artifacts due to hepatic activity in technetium-99 m myocardial perfusion SPECT studies. J Nucl Med 35:356–359PubMed

43.

Hurwitz GA, Clark EM, Slomka PJ, Siddiq SK (1993) Investigation of measures to reduce interfering abdominal activity on rest myocardial images with Tc-99 m sestamibi. Clin Nucl Med 18:735–741PubMedCrossRef

44.

Kirch D, Koss J, Bublitz T, Steele P (2004) False-positive findings on myocardial perfusion SPECT. J Nucl Med 45:1597PubMed

45.

Forster S, Rieber J, Ubleis C, Weiss M, Bartenstein P, Cumming P, Klauss V, Hacker M (2010) Tc-99 m sestamibi single photon emission computed tomography for guiding percutaneous coronary intervention in patients with multivessel disease: a comparison with quantitative coronary angiography and fractional flow reserve. Int J Cardiovasc Imaging 26:203–213PubMedCrossRef

46.

Gorlin R, Brachfeld N, MacLeod C, Bopp P (1959) Effect of nitroglycerin on the coronary circulation in patients with coronary artery disease or increased left ventricular work. Circulation 19:705–718PubMedCrossRef

47.

Fleming RM, Harrington GM (2011). Chapter 13. Fleming Harrington redistribution wash-in washout (FHRWW): the platinum standard for nuclear cardiology. In: Fleming RM (ed) Establishing better standards of care in doppler echocardiography, computed tomography and nuclear cardiology. Intech Publishing. ISBN: 978-953-307-366-8

48.

Fleming RM, Harrington GM, Baqir R, Jay S, Challapalli S, Avery K, Green J (2009) The evolution of nuclear cardiology takes us back to the beginning to develop today’s “new standard of care” for cardiac imaging: how quantifying regional radioactive counts at 5 and 60 minutes post-stress unmasks hidden ischemia. Methodist DeBakey Cardiovasc J (MDCVJ) 5(3):42–48

49.

Fleming RM, Harrington GM, Baqir R, Jay S, Challapalli S, Avery K, Green J (2010) Renewed application of an old method improves detection of coronary ischemia. a higher standard of care. Fed Pract 27:22–31

50.

Fleming RM, Harrington GM, Avery K, Baqir R, Jay S, Challapalli S, Green J (2010). Sestamibi kinetics may distinguish between viable and infracted myocardium. Medscape Radiology 2010 WebMD, LLC

Title: Diagnostic value of myocardial SPECT to detect in-stent restenosis after drug-eluting stent implantation
Authors: Hyo Eun Park
Bon-Kwon Koo
Kyung-Woo Park
Jin Chul Paeng
Hae-Young Lee
Hyun-Jae Kang
Hyo-Soo Kim
Publication date: 01-12-2012
Publisher: Springer Netherlands
Published in: The International Journal of Cardiovascular Imaging / Issue 8/2012
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-012-0036-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diagnostic value of myocardial SPECT to detect in-stent restenosis after drug-eluting stent implantation

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 8/2012

Multicenter assessment of the reproducibility of volumetric radiofrequency-based intravascular ultrasound measurements in coronary lesions that were consecutively stented

Imaging sequences in cardiovascular magnetic resonance: current role, evolving applications, and technical challenges

Aortic annulus dimension assessment by computed tomography for transcatheter aortic valve implantation: differences between systole and diastole

Assessment of right ventricular function by three-dimensional echocardiography and myocardial strain imaging in adult atrial septal defect before and after percutaneous closure

Non-invasive assessment of atherosclerotic coronary lesion length using multidetector computed tomography angiography: comparison to quantitative coronary angiography

Assessment of subclinical left ventricular dysfunction in obstructive sleep apnea patients with speckle tracking echocardiography