Coronary stent occlusion: reverse attenuation gradient sign observed at computed tomography angiography improves diagnostic performance
Coronary stent occlusion: reverse attenuation gradient sign observed at computed tomography angiography improves diagnostic performance
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DOI：
10.1007/s00330-014-3429-x
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发表时间：
2015-02
影响因子：
5.9
通讯作者：
Minghua Li;Jiayin Zhang;Qingyong Zhang;Jingwei Pan;Zhigang Lu;Meng Wei
中科院分区：
文献类型：
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作者：
Minghua Li;Jiayin Zhang;Qingyong Zhang;Jingwei Pan;Zhigang Lu;Meng Wei
ObjectivesTo评估冠状动脉支架闭塞患者中反向衰减梯度（RAG）征的发生率和诊断性能。方法我们回顾性纳入了2周内接受冠状动脉计算机断层扫描血管造影（CCTA）和侵入性冠状动脉血管造影（伊卡）的疑似再狭窄患者。CCTA时的支架闭塞定义为（1）大口径支架（至少3 mm）的完全造影剂充盈缺损，或（2）小口径支架（小于3 mm）患者存在RAG征，或（3）支架图像质量非诊断性的患者存在RAG征。RAG征的诊断性能进一步评估比较伊卡results.ResultsA共162例患者231植入支架。伊卡证实了59例患者（99枚支架）的支架闭塞。59.3%（35/59）的支架闭塞出现RAG征。以患者为基础的分析显示，我们的诊断标准检测支架闭塞的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为79.7%（47/59）、100%（103/103）、100%（47/47）和89.6%（103/115）。受试者工作特征（ROC）分析证实RAG具有上级诊断性能，曲线下面积为0.898。结论在CCTA中观察到的RAG征代表支架远端的逆向侧支血流，对支架闭塞具有高度特异性。既往植入过支架的患者的RAG征表明支架闭塞。·RAG征改善了小口径支架中支架闭塞的检测。
ObjectivesTo evaluate the incidence and diagnostic performance of reverse attenuation gradient (RAG) sign in patients with coronary stent occlusion.MethodsWe retrospectively included patients with suspected restenosis who underwent both coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) within 2 weeks. Stent occlusion at CCTA was defined as (1) complete contrast filling defect of large calibre stents (at least 3 mm), or (2) presence of RAG sign in patients with small calibre stents (less than 3 mm) or (3) presence of RAG sign in patients with non-diagnostic image quality of stents. The diagnostic performance of RAG sign was further assessed by comparison to ICA results.ResultsA total of 162 patients with 231 implanted stents were included. ICA confirmed stent occlusion in 59 patients (99 stents). RAG sign was present in 59.3 % (35/59) of all stent occlusions. As shown by patient-based analysis, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of our diagnostic criteria for detection of stent occlusion were 79.7 % (47/59), 100 % (103/103), 100 % (47/47) and 89.6 % (103/115) respectively. Superior diagnostic performance was confirmed by receiver operating characteristic (ROC) analysis with an area under the curve of 0.898.ConclusionsRAG sign observed at CCTA in patients with coronary stenting represents reverse collateral flow distal to stents and is highly specific to indicate stent occlusion.Key Points•RAG sign in patients with previous stents represents retrograde collateral flow.•RAG sign in patients with previous stents indicates stent occlusion.•RAG sign improves detection of stent occlusion in small calibre stents.