From the Guidelines
The best test to evaluate for complications after stent placement is intravascular ultrasound (IVUS), which can identify stent underexpansion, deformation, and malapposition, as well as edge dissection, hematoma, and tissue protrusion. This is based on the most recent and highest quality study, which recommends intracoronary imaging for postintervention assessment of optimal endpoints and exclusion of complications and adequate stent expansion 1. IVUS provides a unique coronary artery assessment of lesion characteristics, minimal and maximal lumen diameters, cross-sectional area, and plaque area, making it a valuable tool for determining the mechanism of stent restenosis or thrombosis 1.
Some key points to consider when using IVUS for post-stent placement evaluation include:
- Identifying stent underexpansion, deformation, and malapposition
- Identifying edge dissection, hematoma, and tissue protrusion
- Ruling out geographic miss and inflow/outflow disease
- Using IVUS criteria for optimization, such as minimum lumen area (MLA) in the IVUS-stented segment >5.0 mm2 or 90% of the MLA at the distal reference segments 1
It's also important to note that while other imaging modalities, such as duplex ultrasound and CT angiography, may be useful in certain situations, IVUS is the most effective test for evaluating complications after stent placement, particularly in coronary stents 1. Regular clinical assessment and laboratory monitoring of platelet function or drug levels may also be indicated in patients on dual antiplatelet therapy to ensure proper medication effectiveness and reduce thrombosis risk.
From the Research
Best Test for Bad After Stent Placement
The best test for detecting issues after stent placement is a topic of interest in cardiology. Several studies have investigated the use of different imaging modalities for this purpose.
- Coronary CT angiography (CCTA) is a highly sensitive method for detecting coronary plaques and has been shown to be valuable in ruling out in-stent restenosis 2.
- A study using third-generation dual-source CT scanners found that CCTA was able to rule out in-stent restenosis in almost two-thirds of symptomatic patients with previous coronary stent implantation 2.
- Another study found that multi-slice CT coronary angiography (CT-CA) may play a clinical role in the follow-up of coronary stents, although it requires highly selected populations and demanding performance requirements 3.
- Invasive coronary angiography (ICA) is still considered the gold standard for detecting in-stent restenosis, but it is an invasive procedure with associated risks and complications 4, 5.
- A study with long-term follow-up found that coronary stenting seemed to be clinically sustained at 7 to 11 years of follow-up, but late luminal renarrowing beyond 4 years was common, demonstrating the need for further follow-up 6.
Key Findings
- CCTA is a valuable tool for safely excluding in-stent restenosis and may help avoid invasive diagnostic procedures 2.
- The rate of false-negative findings with CCTA is low, but the rate of false-positive or inconclusive findings is higher, leading to invasive rule-out of in-stent restenosis by ICA in some cases 2.
- Invasive coronary angiography is still necessary in some cases to confirm or rule out in-stent restenosis, especially in patients with unclear or false-positive findings on CCTA 2.
- Long-term follow-up is necessary to detect late luminal renarrowing beyond 4 years after stent placement 6.