CTA Holds Promise for Interventionalists
Multislice CTA is efficacious for pre- and post-intervention coronary evaluation.
The integration of coronary computed tomographic angiography CTA into the management of interventional cardiologists is not yet fully justified, but its use is no longer premature, according to Patrick W. Serruys, MD, PhD, Professor of Intervetnional Cardiology at the Interunversity Cardiological Institute, The Netherlands, and Erasmus University.
In his presentation, Serruys explored preinterventional coronary imaging specifically for detection of stenoses and assessment of bifurcations and chronic total occlusions.
Preintervention
Serruys cited per-patient analysis studies showing the sensitivity and specificity of 64-slice CTA for detecting stenosis (Figure). The newest CT scanning technology is a dual-source CT scanner that provides temporal resolution of 83 ms, data acquisition < 10 s, and a radiation dose of 10 mSv.
A 2005 study of 312 patients reported the efficacy of a multislice CT image for evaluation of coronary bifurcations: specificity rate was 99%; positive predictive value, 85%; negative predictive value, 99%.
Multislice CTA has also been successfully applied to assessment and recanalization of chronic total occlusions.
Imaging follow-up
Serruys also discussed the use of CTA in coronary imaging follow-up of stented main stem lesions and bioabsorbable stents. One study considered 64-slice CTA for assessing restenosis after left main stenting. In that 70-patient study, the sensitivity rate was 100% and the specificity rate was 91%.
“Today, we can noninvasively diagnose stenosis with multislice CT and assess noninvasively the long-term results of a non radio-opaque absorbable stent,” Serruys said. A prospective, randomized trial is currently under way to fully establish the cost effectiveness of this new approach.