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European Heart Journal Advance Access originally published online on February 25, 2005
European Heart Journal 2005 26(13):1284-1291; doi:10.1093/eurheartj/ehi165
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Comparison of synchrotron radiation angiography with conventional angiography for the diagnosis of in-stent restenosis after percutaneous transluminal coronary angioplasty

Bernard Bertrand1,2,*, François Estève1,3, Hélène Elleaume1, Christian Nemoz4, Stefan Fiedler4, Alberto Bravin4, Gilles Berruyer4, Thierry Brochard4, Michel Renier4, Jacques Machecourt2, William Thomlinson5 and Jean-François Le Bas1,3

1INSERM-U647/ESRF, Grenoble, France
2Department of Cardiology, Grenoble University Hospital, BP217 38043 Grenoble, France
3MRI Unit, Grenoble University Hospital, Grenoble, France
4ID17-ESRF, Grenoble, France
5Canadian Light Source, Saskatoon, Canada

Received 21 August 2004; revised 12 January 2005; accepted 13 January 2005; online publish-ahead-of-print 25 February 2005.

* Corresponding author. Tel: +33 476 765 507; fax: +33 476 765 623. E-mail address: bbertrand{at}chu-grenoble.fr

Aims Synchrotron radiation angiography (SRA) is a novel tool for minimally invasive coronary artery imaging. The method uses subtraction of two images produced at energies bracketing the iodine K-edge after intravenous infusion of iodinated contrast agent. We investigated the accuracy of SRA for detecting in-stent restenosis (ISR).

Methods and results We recruited 57 men, 4–6 months after successful PTCA. We visualized the right coronary artery (RCA) in 27 patients with 36 stented segments [12 segments with ISR>50% by quantitative coronary angiography (QCA)], and the left anterior descending artery (LAD) in 30 patients with 37 stented segments (10 ISR). SRA and QCA were performed within 2 days of each other. Two experienced observers unaware of QCA data evaluated the SRA results. Image quality was good or excellent in most patients. Global sensitivity was 64%, specificity was 95%, and positive and negative predictive values were ~85%. Inter-observer kappa concordance coefficient was 0.86. False negatives involved short eccentric lesions and superimposed segments, most frequently of the LAD. False positives occurred in intermediate stenoses slightly overestimated by SRA.

Conclusion In men, this minimally invasive approach, using small radiation doses, detects significant ISR in the RCA, but the LAD poses difficulties because of superimposition with others structures.

Key Words: Angiography • Coronary disease • Restenosis • Stents • Synchrotron radiation


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