MDCT Application for Coronary Artery Intervention

ABSTRACT

Multidetector computed tomography (MDCT) has recently been used as a diagnostic tool for the evaluation of coronary artery morphology and stenosis. The accuracy of MDCT has improved as the number of detectors of MDCT has increased. A 64-MDCT reliably detects significant coronary artery stenosis with a sensitivity and specificity higher than 90%. With its high negative predictive value near 100%, 64-MDCT is very practical for excluding significant coronary artery disease and avoiding unnecessary invasive coronary angiography. Furthermore, preprocedural MDCT coronary angiography is useful to provide additional information and predict the procedural outcomes particularly in patients who have chronic total occlusion and those referred for percutaneous coronary intervention. Postprocedural MDCT coronary angiography usually involves evaluation of in-stent restenosis. Recently, drug-eluting stents are widely used and has notably reduced the rate of in-stent restenosis. However, the rate of in-stent restenosis of drug-eluting stents are still 5~10%. Considering the large number of patients who receive coronary artery stents, MDCT would be clinically useful as a noninvasive tool for the reliable detection of in-stent restenosis. Even with 64-MDCT, 30~40% of stents are not evaluable because the spatial and temporal resolutions are not sufficient for the detection of in-stent restenosis. With the 64-MDCT technology, the accessibility of in-stent restenosis mainly depends on stent size and severity of metal artifact of stents. Although the current MDCT does not permit reliable detection of in-stent restenosis, MDCT can be accepted as a first-line alternative to coronary angiography for the evaluation of stents, especially those with a large diameter such as left main coronary artery stents.