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European Heart Journal Advance Access published online on February 25, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi165
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved

Clinical research

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

Bernard Bertrand 1*, François Estève 2, Hélène Elleaume 3, Christian Nemoz 4, Stefan Fiedler 4, Alberto Bravin 4, Gilles Berruyer 4, Thierry Brochard 4, Michel Renier 4, Jacques Machecourt 5, William Thomlinson 6, and Jean-François Le Bas 2

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

* To whom correspondence should be addressed.
Bernard Bertrand, E-mail: bbertrand{at}chu-grenoble.fr


  Abstract

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.

Keywords: Angiography; Coronary disease; Restenosis; Stents; Synchrotron radiation.
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