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Postangioplasty Restenosis
Darragh Brady, MD; John Duignan, MB BCh, BAO, MRCPI; Jonathan D. Dodd, MD, MSc, MRCPI, FFR(RCSI)
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Postangioplasty restenosis is recurrent narrowing of coronary artery treated by either balloon angioplasty or percutaneous coronary intervention
              • In-stent restenosis (ISR): Recurrent stenosis > 50% (by diameter) at stent site or its edges (adjacent 5 mm)

            IMAGING

            • General Features

              • CT Findings

                • Angiographic Findings

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Staging, Grading, & Classification

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Image Interpretation Pearls

                                Selected References

                                1. Dai T et al: Diagnostic performance of computed tomography angiography in the detection of coronary artery in-stent restenosis: evidence from an updated meta-analysis. Eur Radiol. 28(4):1373-82, 2018
                                2. Her AY et al: Current management of in-stent restenosis. Korean Circ J. 48(5):337-49, 2018
                                3. Li Y et al: Third generation dual-source CT enables accurate diagnosis of coronary restenosis in all size stents with low radiation dose and preserved image quality. Eur Radiol. 28(6):2647-54, 2018
                                4. Kalisz K et al: Artifacts at cardiac CT: physics and solutions. Radiographics. 36(7):2064-83, 2016
                                5. Giacoppo D et al: Treatment strategies for coronary in-stent restenosis: systematic review and hierarchical Bayesian network meta-analysis of 24 randomised trials and 4880 patients. BMJ. 351:h5392, 2015
                                6. Park SJ et al: In-stent neoatherosclerosis: a final common pathway of late stent failure. J Am Coll Cardiol. 59(23):2051-7, 2012
                                7. Abdelkarim MJ et al: Noninvasive quantitative evaluation of coronary artery stent patency using 64-row multidetector computed tomography. J Cardiovasc Comput Tomogr. 4(1):29-37, 2010
                                8. Hecht HS et al: Stent gap by 64-detector computed tomographic angiography relationship to in-stent restenosis, fracture, and overlap failure. J Am Coll Cardiol. 54(21):1949-59, 2009
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Imaging

                                    • Top Differential Diagnoses

                                      • Pathology

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Definitions

                                            • Postangioplasty restenosis is recurrent narrowing of coronary artery treated by either balloon angioplasty or percutaneous coronary intervention
                                            • In-stent restenosis (ISR): Recurrent stenosis > 50% (by diameter) at stent site or its edges (adjacent 5 mm)

                                          IMAGING

                                          • General Features

                                            • CT Findings

                                              • Angiographic Findings

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • General Features

                                                    • Staging, Grading, & Classification

                                                      CLINICAL ISSUES

                                                      • Presentation

                                                        • Demographics

                                                          • Treatment

                                                            DIAGNOSTIC CHECKLIST

                                                            • Image Interpretation Pearls

                                                              Selected References

                                                              1. Dai T et al: Diagnostic performance of computed tomography angiography in the detection of coronary artery in-stent restenosis: evidence from an updated meta-analysis. Eur Radiol. 28(4):1373-82, 2018
                                                              2. Her AY et al: Current management of in-stent restenosis. Korean Circ J. 48(5):337-49, 2018
                                                              3. Li Y et al: Third generation dual-source CT enables accurate diagnosis of coronary restenosis in all size stents with low radiation dose and preserved image quality. Eur Radiol. 28(6):2647-54, 2018
                                                              4. Kalisz K et al: Artifacts at cardiac CT: physics and solutions. Radiographics. 36(7):2064-83, 2016
                                                              5. Giacoppo D et al: Treatment strategies for coronary in-stent restenosis: systematic review and hierarchical Bayesian network meta-analysis of 24 randomised trials and 4880 patients. BMJ. 351:h5392, 2015
                                                              6. Park SJ et al: In-stent neoatherosclerosis: a final common pathway of late stent failure. J Am Coll Cardiol. 59(23):2051-7, 2012
                                                              7. Abdelkarim MJ et al: Noninvasive quantitative evaluation of coronary artery stent patency using 64-row multidetector computed tomography. J Cardiovasc Comput Tomogr. 4(1):29-37, 2010
                                                              8. Hecht HS et al: Stent gap by 64-detector computed tomographic angiography relationship to in-stent restenosis, fracture, and overlap failure. J Am Coll Cardiol. 54(21):1949-59, 2009