Abstract

Background: The aim of our study was to assess the sensitivity and accuracy of computed tomography angiography (CTA) for the detection of variable degrees of iliac artery in-stent restenosis compared with digital subtraction angiography (DSA).
Material/Methods: Twenty patients (39 women, 43%; 51 men, 57%) with suspected iliac in-stent restenosis were prospectively evaluated with CTA using a 64-row multidetector CT scanner and DSA examination. The patients’ mean age was 63 ±6 years (range, 56 to 81 years). DSA and CTA studies were performed during one hospital stay. Ninety uncovered implanted commercially available stents were suspected of in-stent restenosis: 14 stainless-steel Express Vascular LD, 26 Wallstent, and 50 nitinol Smart stents. Restenosis in the stented segments were divided into four categories: A – minimal intimal hyperplasia in the stented segment <30%; B – hyperplasia obstructing <50% of the lumen diameter in the stented segment; C – hyperplasia obstructing <99% of the lumen diameter in the stented segment; and D – occluding the intimal hyperplasia in the stented segment.
Result: It was possible to visualize the stent diameter, lumen, and degree of in-stent restenosis. Comparisons between CTA and DSA in-stent restenosis in the B, C, and D groups were identical (sensitivity and specificity were 100%). In group A, the sensitivity was 100%, but the specificity was only 80%.
Conclusions: This study demonstrated that 64-row multidetector CTA is a sensitive and accurate noninvasive vascular imaging investigation to detect in-stent restenosis in iliac arteries. Final evaluation needs routine postprocessing analysis. CTA allows radiologists and surgeon to plan corrective endovascular procedures.

Keywords: Iliac Artery, in-stent restenosis, multidetector-CT-angiography , DSA