Document Detail

CT Imaging of Coronary Stents: Past, Present, and Future.
Jump to Full Text
MedLine Citation:
PMID:  22997590     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Coronary stenting became a mainstay in coronary revascularization therapy. Despite tremendous advances in therapy, in-stent restenosis (ISR) remains a key problem after coronary stenting. Coronary CT angiography evolved as a valuable tool in the diagnostic workup of patients after coronary revascularization therapy. It has a negative predictive value in the range of 98% for ruling out significant ISR. As CT imaging of coronary stents depends on patient and stent characteristics, patient selection is crucial for success. Ideal candidates have stents with a diameter of 3 mm and more. Nevertheless, even with most recent CT scanners, about 8% of stents are not accessible mostly due to blooming or motion artifacts. While the diagnosis of ISR is currently based on the visual assessment of the stent lumen, functional information on the hemodynamic significance of in-stent stenosis became available with the most recent generation of dual source CT scanners. This paper provides a comprehensive overview on previous developments, current techniques, and clinical evidence for cardiac CT in patients with coronary artery stents.
Andreas H Mahnken
Publication Detail:
Type:  Journal Article     Date:  2012-09-11
Journal Detail:
Title:  ISRN cardiology     Volume:  2012     ISSN:  2090-5599     ISO Abbreviation:  ISRN Cardiol     Publication Date:  2012  
Date Detail:
Created Date:  2012-09-21     Completed Date:  2012-09-24     Revised Date:  2013-04-02    
Medline Journal Info:
Nlm Unique ID:  101566293     Medline TA:  ISRN Cardiol     Country:  Egypt    
Other Details:
Languages:  eng     Pagination:  139823     Citation Subset:  -    
Department of Diagnostic and Interventional Radiology, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): ISRN Cardiol
Journal ID (iso-abbrev): ISRN Cardiol
Journal ID (publisher-id): ISRN.CARDIOLOGY
ISSN: 2090-5580
ISSN: 2090-5599
Publisher: International Scholarly Research Network
Article Information
Download PDF
Copyright © 2012 Andreas H. Mahnken.
Received Day: 25 Month: 7 Year: 2012
Accepted Day: 16 Month: 8 Year: 2012
collection publication date: Year: 2012
Electronic publication date: Day: 11 Month: 9 Year: 2012
Volume: 2012E-location ID: 139823
ID: 3446716
PubMed Id: 22997590
DOI: 10.5402/2012/139823

CT Imaging of Coronary Stents: Past, Present, and Future
Andreas H. MahnkenI1*
Department of Diagnostic and Interventional Radiology, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
Correspondence: *Andreas H. Mahnken:
[other] Academic Editors: F. Cademartiri and S.-J. Park

1. Rationale for CT Imaging of Coronary Stents

Coronary artery stenting was pioneered in the mid 1980s [1]. It rapidly replaced “plain old balloon angioplasty” for coronary revascularization and became the most commonly used revascularization technique in obstructive coronary artery disease. The major drawback of coronary artery stenting is the occurrence of in-stent restenosis (ISR), which has been reported to occur in 11 to 46% at 6 months in bare metal stents (BMS) [2]. With introduction of drug eluting stents (DES), early ISR became less common and nowadays about 76% of revascularizations are performed using DES [3]. However, ISR still poses a major problem in coronary revascularization therapy with more than 200.000 estimated cases of DES ISR in the US alone. Late catchup in ISR when using DES has also been discussed [4, 5]. Moreover, in-stent thrombosis has been identified as a relevant problem in DES [6]. Another potential late complication of DES is the occurrence of stent fractures. The latter is considered a predisposing factor for ISR and late thrombosis. Coronary stent fractures are diagnosed in about 3% of patients [7], but autopsy data reports a much higher frequency of up to 29% [8].

While acute in-stent thrombosis typically becomes symptomatic with chest pain, the detection of ISR is more problematic as patients are often asymptomatic and about half of the patients with significant ISR do not experience any symptoms [9]. In addition, even complex noninvasive diagnostic tests such as myocardial single photon emission computed tomography (SPECT) yield only moderate results for detecting ISR [10, 11]. As a consequence, direct stent imaging appears to be worthwhile. Coronary catheter angiograms are costly and associated with a 0.1% mortality [12], whereas coronary magnetic resonance (MR) angiography after coronary stenting is still in an experimental stage [13]. Thus, coronary computed tomography (CT) angiography evolved as the only non-invasive diagnostic test allowing for direct visualization of coronary stents and, therefore, non-invasive detection of ISR, stent thrombosis and stent fractures.

2. CT Imaging of Coronary Stents: The Past

The first report on localizing a coronary stent with unenhanced electron beam CT (EBCT) was published in 1995 [14]. Few groups generated a small amount of data on the use of EBCT for assessing coronary stent patency. Due to the limited spatial resolution of EBCT, direct visualization of the stent lumen was not possible and an indirect approach was applied to assess stent patency. For this purpose, contrast enhancement was determined distally to the stent and compared with the contrast enhancement pattern proximal to the stented segment, in the thoracic aorta or the left ventricle. Stent patency was assumed if the contrast enhancement distally to the stent matched the proximal coronary, aortic or left ventricular contrast enhancement pattern [15, 16]. Applying this technique, one has to be aware that contrast enhancement distal to any obstructed stent is influenced by retrograde filling via collateral vessels. Using this approach, a sensitivity of about 48–100% for detecting ISR or stent occlusion with a high negative predictive value of 80.5–100% was achieved (Table 1) [17]. For several reasons, including the inability to quantitatively assess the degree of ISR and its limited availability, EBCT imaging of coronary stents did not gain clinical acceptance and was soon pushed aside by multislice CT (MSCT).

With the simultaneous introduction of 4-slice CT scanners by all major vendors in 1998 and introduction of gating techniques for cardiac MSCT in 2000 [20], 4-slice CT became the first intensely used non-invasive imaging modality for assessing coronary artery stents. With its limited temporal and spatial resolution, direct visualization of the stent lumen was almost impossible and early studies focused on the visual assessment of the distal runoff [21]. This approach permitted the reliable detection of stent occlusion, but reliable assessment of ISR was not possible. Moreover, contrast enhancement distal to any stent is no absolute indicator of stent patency as retrograde filling via collaterals may also result in peripheral contrast enhancement. Dynamic assessment of coronary contrast enhancement, as it has been established for the EBCT assessment of coronary stents, was only sporadically reported [22].

Direct visualization of the stent lumen became feasible after 16-slice CT with improved temporal resolution and submillimeter spatial resolution was introduced in 2002. Only then, coronary CT angiography gained broader acceptance. With 16-slice CT direct assessment of the stent lumen became the primary goal of the examination in order to directly visualize ISR. The results from several studies on CT imaging of coronary stents were promising with sensitivities of 54% to 100% for detecting ISR (Table 2). Results were particularly promising after stenting of coronary artery bypass graft, where motion is markedly less and stents are bigger when compared with native coronary vessels [36]. However, on average, about 14% of stents were not evaluable with 16-slice CT [40] and even under ideal conditions in several phantom studies, only an average of 54% of the stent lumen were visible with CT [41, 42]. Gilard and coworkers showed that larger stents allowed for a better assessability of the stent lumen. Correspondingly, the sensitivity for detecting ISR increased from 54% in stents with a diameter of ≤3 mm to 86% in stents >3 mm [30]. These findings were also confirmed by data from phantom studies [43]. Using 16-slice CT technology, the basics for modern CT imaging of coronary stents including image acquisition, postprocessing, and data analysis were elaborated and the requirements for the rapid advancement of scanner hard- and software were identified.

3. Issues in CT Imaging or Coronary Stents

There are some specific technical issues in CT imaging of coronary stents. These include blooming artifacts due to beam hardening and partial volume effect, motion artifacts, geometric effects due to cardiac anatomy, and, last but not least, intravascular contrast enhancement.

Blooming is probably the most discussed issue in coronary stent imaging. It is mainly due to metal artifacts and the partial volume averaging effect. Blooming describes an effect where the stent struts appear to be thicker, causing an underestimation of the stent lumen. In fact, the presence of high-density objects such as the metal struts from stents or dense calcifications cause beam hardening, where lower energy photons of the X-ray beam are more rapidly absorbed, causing the beam to be more intense once it reaches the detector. Partial volume averaging also contributes to blooming artifacts. It is inherent with CT, as the CT number of each voxel represents the average attenuation of the materials within the voxel. In some situations, dark streaks, known as streak artifacts, may also be seen in the presence of metal. The latter are mostly due to a lack of attenuation data and an inaccurate beam hardening correction in filtered back projection.

There are several approaches to solve these problems, with minimizing the amount of metal being the most obvious solution. Consequently, stents with thin struts and a low metal to surface ratio are thought to cause fewer artifacts. In contrast, blooming is more pronounced in the presence of overlapping stent placement or complex scenarios such as bifurcation lesions where Y-, V-, T-, or crush stenting techniques were applied. The presence of heavy calcifications in a stented segment further aggravates metal artifacts as it contributes to beam hardening. However, in clinical routine practice, these relationships are not that simple. In several clinical studies strut thickness had no significant effect on image quality [44, 45], although stents with a strut thickness of more than 100–140 μm appear to be associated with poorer image quality [46, 47] (Figure 1).

The type of stent is also known to affect the results. With the atomic number having a disproportionally high effect on attenuation, the stent material is essential, too. Generally speaking, a relatively low density of the metal as in magnesium or cobalt-chromium alloys appears to be advantageous [48]. Consequently stents or stent markers made from materials with high atomic numbers such as gold or tantalum cause markedly more artifacts when compared with stents made from stainless steel or alloys such as elgiloy and nitinol [42, 49].

Another technique for minimizing metal artifacts is the use of high kV imaging to avoid the photon starvation effect. However, this will result in an increased radiation exposure of the patient and should therefore be avoided whenever possible. As partial volume averaging contributes to blooming artifacts, the use of thin sections and a small field of view is recommendable. In fact, improvements in spatial resolution had probably the greatest effect on improving visibility of the stent lumen. This has been shown with experimental high resolution CT scanners [50, 51] as well as in phantom studies using clinical CT scanners [52]. Only recently, dual energy techniques including so-called monoenergetic imaging or iterative reconstruction techniques became available for coronary imaging, providing new approaches towards the reduction of metal artifacts [53, 54].

Interestingly, metal artifacts reduction algorithms as they were developed for CT imaging in the presence of metallic implants such as total hip replacement were never tested in cardiac CT. Instead, many vendors provide dedicated convolution kernels for image reconstruction. These (sharp) convolution kernels are designed to enhance the edges of high attenuation structures such as stent struts. Thereby, the blooming decreases at the costs of an increased image noise [55]. With current iterative reconstruction techniques a powerful tool for reducing image noise became available, compensating for the increased image noise [56]. The use of these dedicated reconstruction kernels is strongly recommended for assessing stent lumen, while the nonstented coronary artery segments should be assessed from image data reconstructed with a standard cardiac convolution kernel (Figure 2).

Like in any type of coronary CT angiography motion artifacts either due to breathing or cardiac motion need to be overcome. With scan times below 10 s in 64-slice dual source CT (DSCT) scanners motion artifacts due to breathing does not pose a relevant problem anymore. Residual cardiac motion still poses a major problem. It causes blurring and particularly in high contrast objects such as coronary stents it disproportionally exacerbates the negative effects of blooming on image quality. Image quality and reliability of CT-value measurements inside stents are known to deteriorate with increasing heart rate [57]. Lowering the heart rate and improving temporal resolution are standard approaches towards this issue. In the particular setting of coronary stent imaging, however, improving the temporal resolution by means of multisegmental image reconstruction did not prove beneficial. Groen and coworkers even concluded that reduction in heart rate is more effective than improving the temporal resolution [58].

From several phantom studies, it is known that the angulation of the stent to the scan plane has a relevant effect on the visibility of the stent lumen [52, 59]. The lumen is described to be best visible if the stent was positioned 0° or 90° to the z-axis. However, except for the mid-section of the right coronary artery, the course of the coronary arteries is typically angulated. Thus, anatomy adds to the difficulties in CT imaging of coronary stents.

In addition to the scanner-related aspects, a sufficient intravascular contrast enhancement, ideally of more than 250 HU, is needed. This is a prerequisite for coronary CT angiography, but, in coronary stent imaging, a distinct contrast enhancement is of even more importance, as other factors such as image noise due to sharp convolution kernels or beam hardening artifacts in the presence of stents negatively affect contrast-to-noise ratios. Moreover, the selection of optimized windows settings, as described in Section 4, requires a good intravascular attenuation to permit delineation of vessel lumen, neointima inside the stent, and metal from the stent struts.

4. Considerations for Image Assessment

Coronary stent patency and ISR may be assessed in different ways. In the early days of coronary (4 slice), CT angiography direct visualization of the stent lumen was not possible. At that time, the intracoronary contrast enhancement distal to the stent was assessed as an indicator of stent patency. However, it is no absolute measure and may be false positive due to retrograde filling. Moreover, it does not provide information on the degree of ISR. A different approach uses dynamic scans as described for EBCT. The quantitative assessment of time-enhancement curves proximal and distal to a stent might be more reliable than mere visual assessment. This hypothesis, however, has not yet been validated.

With introduction of 16-slice CT scanners, more reliable approaches were sought. One of these techniques is the so-called pixel count method, where all pixels inside the stent lumen with a CT value above the lowest CT value proximal to the stent are counted in order to determine the presence of a stenosis. If more than 50% of the voxels inside a stent fulfilled this criterion, relevant ISR was assumed [32]. However, with a sensitivity and specificity of 75% and 88%, this method did not find its way into clinical routine practice. In another approach, the difference of the CT-values measured proximal and inside a stent were shown to be a good predictor of an at least 50% ISR, with a difference of 75 Hounsfield units (HU) being the most reliable threshold [38]. The most obvious technique, direct visualization of the stent lumen, proved to be the most reliable technique and was finally accepted as standard of practice. Although blooming still hampers this approach, it became accepted as is the most intuitive and easiest way. By using a wide window of ≥700 HU with a center of about 200 HU, there appears to be an acceptable tradeoff between blooming and visibility of the stent lumen. In addition, the CT values proximal and inside a stent are commonly measured [60]. However, one has to be aware that beam hardening usually causes a 60–100 HU overestimation of the CT-values inside a coronary stent. Therefore, measuring CT values is of limited value, while the visual assessment of attenuation differences, as they may be seen in stenotic lesions, are considered sufficiently reliable with 64-slice CT scanners.

5. CT Imaging of Coronary Stents: Current Status

In the first decade of CT imaging of coronary artery stents, lessons on the ideal scan protocol and image assessment were learned as described above. With introduction of 64-slice CT scanners, coronary CT angiography and concomitantly coronary stent imaging experienced its breakthrough in clinical routine practice. The increase in the number of slices from 4 to 64 went along with a decrease in section thickness from 1.25 mm to 0.5 mm and an increase in temporal resolution from about 250 ms to 83 ms or less.

Despite these marked improvements in scanner hardware, phantom studies still indicate relevant limitations of CT imaging of coronary artery stents with an artificial lumen narrowing in the range of 10% to 60% depending on the type of stent [48, 52]. With smaller stents, the artificial lumen narrowing is even more pronounced [61].

On first sight, these phantom studies still appear discouraging, but the clinical evidence tells a different story. Like conventional coronary, CT angiography for coronary artery disease, the application of 64-slice coronary CT angiography has a very high negative predictive value in range of 78–100% for exclusion of in-stent restenosis, while its positive predictive value is markedly worse (25–100%; Table 3). These results further improved with recent DSCT scanners (Table 4). Moreover, the number of stented segments, which had to be excluded from analysis progressively decreased from an average of 14% in 16-slice CT [62] to 8% with state-of-the-art scanners (Table 4).

There are three meta-analyses on the value of 64-slice CT imaging in coronary artery stents [8486]. The overall sensitivity, specificity, PPV, and NPV for assessable stents as reported by Kumbhani and coworkers were 91%, 91%, 68%, and 98%. If all stents were included in the analysis, the overall sensitivity, specificity, PPV, and NPV decreased to 87%, 84%, 53%, and 97%, respectively [85]. These results were much better when compared with earlier meta-analyses based on a mixture of 16- and 64-slice CT [62, 87], indicating the positive effect of improved spatial and temporal resolution on image quality. However, the interpretation of these current results is still controversial. Two of the meta-analyses on 64-slice CT are based on the identical set of clinical studies, but come to controversial conclusions. While Sun and Almutairi consider 64-slice CT as a reliable alternative to conventional coronary angiography [86], Kumbhani et al. conclude that stress imaging remains the most acceptable noninvasive technique for diagnosing ISR [85].

With 64-slice, CT blooming and motion artifacts due to heart rate variations including arrhythmias were the most common causes for impaired image quality. In addition, stent-related factors such as stent diameter, strut thickness, stent design, and type of stent placement (e.g., overlapping stenting) were shown to influence the visibility of coronary stent lumen. There is a consensus that stents with a diameter below 3 mm are more likely to be inaccessible than stents with a diameter of 3 mm or more [60, 66, 72, 88]. At large, thick stent struts are more likely to go along with an inaccessible stent lumen. However, there is no generally accepted definition of thin or thick struts and different thresholds have been used in the literature [71, 89]. In addition, more complex procedures with bifurcation or overlapping stenting, where there are multiple layers of metal cause more blooming, thereby limiting the visibility of the stent lumen [64, 88]. The effect of the stent design remains unclear as no differences were found between open and closed cell design [47, 68].

6. CT Imaging of Coronary Stents Beyond ISR

Most non-invasive imaging strategies in the presence of coronary stents focus on ISR as it is often asymptomatic, despite hemodynamic relevance of a stenosis. In contrast, in-stent thrombosis typically goes along with chest pain and requires acute therapy. Correspondingly, there is almost no data on the diagnostic value of cardiac CT in in-stent thrombosis. In an initial series including 79 patient with acute onset of chest pain, the sensitivity, specificity, and positive, and negative predictive values of 64-slice CT for the detection of in-stent thrombosis were 95%, 93%, 83%, and 98%, respectively [94]. When considering these data, one has to be aware that this setting is not an appropriate indication for cardiac CT [95].

Stent fractures are a completely different issue. Considering the discrepancy between 3% clinically suspected stent fractures and a reported occurrence of up to 29% in autopsy series, new diagnostic strategies are needed to deal with this issue [7, 8]. This is of particular relevance as stent fractures are thought to be a predisposing factor for ISR and in-stent thrombosis [96] (Figure 3). So far, there is only scarce data on this topic. Data from a phantom study indicates that 64-slice CT is more accurate than conventional cineangiography for detecting coronary stent fractures with an overall accuracy of 84.1% for CT versus 73.9% for fluoroscopy [97]. This has also been confirmed in the only patient series dealing with stent fractures [98]. A study by Hecht et al. focused on the detection of stent gaps by means of coronary CT angiography. The latter either represent stent fracture or overlap failure. CT has been shown to be markedly more sensitive for detecting gaps between multiple stents, when compared with fluoroscopy (16.9% versus 1.0%) [99]. Considering the currently available data, cardiac CT appears to be better suited than conventional coronary angiography for detecting stent fractures and cardiac CT might be the method of choice for detecting coronary stent fractures. While stent gaps were shown to be associated with ISR [99], the clinical relevance of these findings has still to be determined.

7. Discussion

CT imaging of coronary stents rapidly evolved from a scientific toy to a clinical tool. This development is reflected by its consideration in the current guidelines on coronary CT angiography. While in the 2006 American Heart Association (AHA) scientific statement on cardiac computed tomography CT imaging of stents was generally discouraged [100], it is now considered appropriate in some indications such as for risk assessment after revascularization in asymptomatic patients with a history of left main coronary artery stenting and a stent diameter of equal or more than 3 mm. While it is still considered inappropriate in stents smaller than 3 mm, its value in symptomatic patients is unknown [95]. Accordingly, the 2010 expert consensus on the use of cardiac CT stated “Thus, in a patient known to have larger stents and whose clinical presentation suggests low-to-intermediate probability for restenosis, 64-channel coronary CTA may be a reasonable alternative to invasive angiography to rule out significant in-stent restenosis” [101].

These recommendations reflect the evidence on 64-slice cardiac CT. With DSCT and up to 320-slice single source CT scanners, further achievements were made. The significance of these improvements is likely to be valued in updated guidelines. As CT is quick and non-invasive, it is usually preferred by patients over invasive or lengthy procedures such as catheter angiography or MR imaging. Moreover, it is cheaper and requires almost no preparation time. However, there are some drawbacks including the patient's exposure to contrast material and radiation. Only recently, several investigators compared prospectively ECG-triggered sequential and retrospectively ECG-gated spiral scanning. While there were no relevant differences in stent assessment, this technique allowed for cutting down the radiation exposure by 75%. With 2.2–5.7 mSv, it is in the range of the annual exposure to background radiation [76, 81, 90]. Another shortcoming is the fact that these encouraging results do not apply for all types and sizes of coronary stents as shown above. Nevertheless, coronary CT angiography provides better results for detecting ISR than any other non-invasive diagnostic test including myocardial SPECT [10, 11].

8. Future Perspectives

Several current developments will further improve coronary stent imaging by means of cardiac CT. Most of these are incremental improvements of scanner hardware such as a further improvement of temporal resolution, which is currently in the range of 75 ms. The continuous improvement in spatial resolution will help to reduce blooming due to the partial volume effect. State-of-the-art CT scanners now have a collimated slice thickness of 0.5 mm and a spatial resolution down to 0.2 mm has been shown to be beneficial for coronary stent imaging [50, 51]. Most recent DSCT scanners permit so-called high pitch scanning, allowing for a dose reduction below 2 mSv [102]. This technique also works in the presence of coronary stents [103], but so far there is no patient data with this technique.

New imaging concepts which combine morphological and functional aspects are the most exciting development. Only recently, CT perfusion imaging became feasible, giving way for new examination strategies, which combine CT angiography and dynamic perfusion imaging for assessing the functional relevance of morphological findings. These features can both be integrated in a single comprehensive CT examination. Initial patient data indicates the effectiveness of this imaging strategy [104]. Alternatively modern hybrid imaging techniques such as PET/CT or SPECT/CT with integrated 64-slice CT scanners permit the combination of morphologic and metabolic imaging. However, these imaging modalities were designed for technically less demanding tasks such as oncologic imaging. Consequently, the CT component of these hybrid modalities usually limps behind the current developments in cardiac CT imaging. Thus, comprehensive single modality examination strategies including perfusion imaging and state-of-the-art morphological imaging are more appealing.

Not only imaging technique is improving, stents theirselves are also changing. While drug eluting stents made from metal are the current mainstay in coronary revascularization therapy, drug eluting biodegradable stents are under clinical evaluation [105]. Naturally, these stents are made of less dense materials with lower atomic numbers, particularly if biodegradable scaffolds are used. These stents will be almost CT transparent, therefore permitting almost unrestricted CT imaging of the stent lumen.

9. Conclusion

Coronary CT imaging of coronary artery stents evolved as a reliable tool in the diagnostic workup of patients after coronary revascularization therapy. With 64 slice or newer generation, CT scanners cardiac CT is well suited to rule out ISR in the presence of coronary stents with a diameter equal to or exceeding 3 mm. In these patients, cardiac CT has to be considered in clinical pathways as an alternative to invasive coronary angiography for the workup of patients with suspected ISR after revascularization. The development and evaluation of comprehensive examination protocols assessing morphology and hemodynamic significance of potential ISR will further enhance the diagnostic potential of cardiac CT after coronary stenting.

1. Sigwart U,Puel J,Mirkovitch V. Intravascular stents to prevent occlusion and restenosis after transluminal angioplastyThe New England Journal of MedicineYear: 1987316127017062-s2.0-00231531782950322
2. Antoniucci D,Valenti R,Santoro GM,et al. Restenosis after coronary stenting in current clinical practiceAmerican Heart JournalYear: 199813535105182-s2.0-00318937409506338
3. Roger VL,Go AS,Lloyd-Jones DM,et al. Heart disease and stroke statistics—2011 update: a report from the American Heart AssociationCirculationYear: 2011125e2e22022179539
4. Vermeersch P,Agostoni P,Verheye S,et al. increased late mortality after sirolimus-eluting stents versus bare-metal stents in diseased saphenous vein grafts. results from the randomized delayed rrisc trialJournal of the American College of CardiologyYear: 20075032612672-s2.0-3444712024717631219
5. Park KW,Kim CH,Lee HY,et al. Does “late catch-up” exist in drug-eluting stents: insights from a serial quantitative coronary angiography analysis of sirolimus versus paclitaxel-eluting stentsAmerican Heart JournalYear: 20101594464532-s2.0-7764910903020211308
6. Stone GW,Moses JW,Ellis SG,et al. Safety and efficacy of sirolimus- and paclitaxel-eluting coronary stentsThe New England Journal of MedicineYear: 20073561099810082-s2.0-3384773664217296824
7. Aoki J,Nakazawa G,Tanabe K,et al. Incidence and clinical impact of coronary stent fracture after sirolimus-eluting stent implantationCatheterization and Cardiovascular InterventionsYear: 20076933803862-s2.0-3384733968717195199
8. Nakazawa G,Finn AV,Vorpahl M,et al. Incidence and predictors of drug-eluting stent fracture in human coronary artery. A pathologic analysisJournal of the American College of CardiologyYear: 20095421192419312-s2.0-7035073416119909872
9. Zellweger MJ,Weinbacher M,Zutter AW,et al. Long-term outcome of patients with silent versus symptomatic ischemia six months after percutaneous coronary intervention and stentingJournal of the American College of CardiologyYear: 200342133402-s2.0-003830453212849656
10. Dori G,Denekamp Y,Fishman S,Bitterman H. Exercise stress testing, myocardial perfusion imaging and stress echocardiography for detecting restenosis after successful percutaneous transluminal coronary angioplasty: a review of performanceJournal of Internal MedicineYear: 200325332532622-s2.0-003733584112603492
11. Park HE,Koo BK,Park KW,et al. Diagnostic value of myocardial SPECT to detect in-stent restenosis after drug-eluting stent implantation The International Journal of Cardiovascular Imaging. In press.
12. Chandrasekar B,Doucet S,Bilodeau L,et al. Complications of cardiac catheterization in the current era: a single-center experienceCatheterization and Cardiovascular InterventionsYear: 20015232892952-s2.0-003512031211246238
13. Spuentrup E,Ruebben A,Mahnken A,et al. Artifact-free coronary magnetic resonance angiography and coronary vessel wall imaging in the presence of a new, metallic, coronary magnetic resonance imaging stentCirculationYear: 20051118101910262-s2.0-1484436225315723984
14. Yamaoka O,Ikeno K,Fujioka H,et al. Detection of Palmaz-Schatz stent by ultrafast CTJournal of Computer Assisted TomographyYear: 19951911281302-s2.0-00288122577822528
15. Schmermund A,Haude M,Baumgart D,et al. Non-invasive assessment of coronary Palmaz-Schatz stents by contrast enhanced electron beam computed tomographyEuropean Heart JournalYear: 19961710154615532-s2.0-00298573548909912
16. Knollmann FD,Möller J,Gebert A,Bethge C,Felix R. Assessment of coronary artery stent patency by electron-beam CTEuropean RadiologyYear: 2004148134113472-s2.0-444431294215175892
17. Pump H,Moehlenkamp S,Sehnert C,et al. Electron-beam CT in the noninvasive assessment of coronary stent patencyAcademic RadiologyYear: 19985128588622-s2.0-00324668089862004
18. Pump H,Möhlenkamp S,Sehnert CA,et al. Coronary arterial stent patency: assessment with electron-beam CTRadiologyYear: 200021424474522-s2.0-034290513310671593
19. Zhou Y,Dai RP,Gao RL,Lü SZ,Chen YD. Clinical evaluation of intracoronary in-stent stenosis by electron-beam CT single flow mode studyZhonghua xin xue guan bing za zhiYear: 20053386876902-s2.0-7334908846716188048
20. Ohnesorge B,Flohr T,Becker C,et al. Cardiac imaging by means of electrocardiographically gated multisection spiral CT: initial experienceRadiologyYear: 200021725645712-s2.0-003375310411058661
21. Krüger S,Mahnken AH,Sinha AM,et al. Multislice spiral computed tomography for the detection of coronary stent restenosis and patencyInternational Journal of CardiologyYear: 2003892-31671722-s2.0-094227300712767539
22. Storto ML,Marano R,Maddestra N,Caputo M,Zimarino M,Bonomo L. Images in cardiovascular medicine. Multislice spiral computed tomography for in-stent restenosisCirculationYear: 200210516p. 20052-s2.0-0012765740
23. Maintz D,Grude M,Fallenberg EM,Heindel W,Fischbach R. Assessment of coronary arterial stents by multislice-ct angiographyActa RadiologicaYear: 20034465976032-s2.0-034525801614616203
24. Ligabue G,Rossi R,Ratti C,Favali M,Modena MG,Romagnoli R. Noninvasive evaluation of coronary artery stents patency after PTCA: role of Multislice computed tomographyRadiologia MedicaYear: 20041081-21281372-s2.0-384314041315269696
25. Mazzarotto P,Di Renzi P,Paluello GM,et al. Comparison between four-slice computed tomography and coronary angiography for the assessment of coronary stentsJournal of Cardiovascular MedicineYear: 2006753283342-s2.0-3374665545816645410
26. Schuijf JD,Bax JJ,Jukema JW,et al. Feasibility of assessment of coronary stent patency using 16-slice computed tomographyAmerican Journal of CardiologyYear: 20049444274302-s2.0-434471440315325923
27. Gilard M,Cornily JC,Rioufol G,et al. Noninvasive assessment of left main coronary stent patency with 16-slice computed tomographyAmerican Journal of CardiologyYear: 20059511101122-s2.0-1114423081815619405
28. Cademartiri F,Mollet N,Lemos PA,et al. Usefulness of multislice computed tomographic coronary angiography to assess in-stent restenosisAmerican Journal of CardiologyYear: 20059667998022-s2.0-2494443715216169364
29. Watanabe M,Uemura S,Iwama H,et al. Usefulness of 16-slice multislice spiral computed tomography for follow-up study of coronary stent implantationCirculation JournalYear: 20067066916972-s2.0-3374448764916723789
30. Gilard M,Cornily JC,Pennec PY,et al. Assessment of coronary artery stents by 16 slice computed tomographyHeartYear: 200692158612-s2.0-2964444132815845613
31. Kitagawa T,Fujii T,Tomohiro Y,et al. Noninvasive assessment of coronary stents in patients by 16-slice computed tomographyInternational Journal of CardiologyYear: 200610921881942-s2.0-3364607695916019087
32. Ohnuki K,Yoshida S,Ohta M,et al. New diagnostic technique in multi-slice computed tomography for in-stent restenosis: pixel count methodInternational Journal of CardiologyYear: 200610822512582-s2.0-3364466782615982759
33. Kefer JM,Coche E,Vanoverschelde JLJ,Gerber BL. Diagnostic accuracy of 16-slice multidetector-row CT for detection of in-stent restenosis vs detection of stenosis in nonstented coronary arteriesEuropean RadiologyYear: 200717187962-s2.0-3384608143216733682
34. Chabbert V,Carrie D,Bennaceur M,et al. Evaluation of in-stent restenosis in proximal coronary arteries with multidetector computed tomography (MDCT)European RadiologyYear: 2007176145214632-s2.0-3424868048917115159
35. Soon KH,Cox N,Chaitowitz I,et al. Non-invasive computed tomography angiography in the assessment of coronary stent patency: an Australian experienceInternal Medicine JournalYear: 20073763603642-s2.0-3444710174117535378
36. Mühlenbruch G,Mahnken AH,Das M,et al. Evaluation of aortocoronary bypass stents with cardiac MDCT compared with conventional catheter angiographyAmerican Journal of RoentgenologyYear: 200718823613692-s2.0-3384646769817242243
37. Tedeschi C,Ratti G,De Rosa R,et al. Usefulness of multislice computed tomography to assess patency of coronary artery stents versus conventional coronary angiographyJournal of Cardiovascular MedicineYear: 2008954854922-s2.0-4204911852518404000
38. Kitagawa T,Yamamoto H,Horiguchi J,et al. Usefulness of measuring coronary lumen density with multi-slice computed tomography to detect in-stent restenosisInternational Journal of CardiologyYear: 200812422392432-s2.0-3874912682617360050
39. Gaspar T,Halon DA,Lewis BS,et al. Diagnosis of coronary in-stent restenosis with multidetector row spiral computed tomographyJournal of the American College of CardiologyYear: 2005468157315792-s2.0-2684447797916226187
40. Hamon M,Champ-Rigot L,Morello R,Riddell JW,Hamon M. Diagnostic accuracy of in-stent coronary restenosis detection with multislice spiral computed tomography: a meta-analysisEuropean RadiologyYear: 20081822172252-s2.0-3904913530217763854
41. Maintz D,Seifarth H,Flohr T,et al. Improved coronary artery stent visualization and in-stent stenosis detection using 16-slice computed-tomography and dedicated image reconstruction techniqueInvestigative RadiologyYear: 200338127907952-s2.0-034484533114627897
42. Mahnken AH,Buecker A,Wildberger JE,et al. Coronary artery stents in multislice computed tomography: in vitro artifact evaluationInvestigative RadiologyYear: 200439127332-s2.0-034741948014701986
43. Suzuki S,Furui S,Kaminaga T,et al. Evaluation of coronary stents in vitro with CT angiography: effect of stent diameter, convolution kernel, and vessel orientation to the z-axisCirculation JournalYear: 2005699112411312-s2.0-2774454408916127198
44. Chung SH,Kim YJ,Hur J,et al. Evaluation of coronary artery in-stent restenosis by 64-section computed tomography: factors affecting assessment and accurate diagnosisJournal of Thoracic ImagingYear: 201025157632-s2.0-7714917347420160604
45. Halon DA,Gaspar T,Adawi S,Peled N,Lewis BS. Coronary stent assessment on multidetector computed tomography: source and predictors of image distortionInternational Journal of CardiologyYear: 2008128162682-s2.0-4614909912017707094
46. Zhao J,Zheng LL,Yang Y. Evaluation of coronary artery in-stent patency using 64-slice computed tomographyCoronary Artery DiseaseYear: 20112254055221959714
47. Andreini D,Pontone G,Bartorelli AL,et al. Comparison of feasibility and diagnostic accuracy of 64-slice multidetector computed tomographic coronary angiography versus invasive coronary angiography versus intravascular ultrasound for evaluation of in-stent restenosisAmerican Journal of CardiologyYear: 200910310134913582-s2.0-6544912580319427427
48. Maintz D,Burg MC,Seifarth H,et al. Update on multidetector coronary CT angiography of coronary stents: in vitro evaluation of 29 different stent types with dual-source CTEuropean RadiologyYear: 200919142492-s2.0-5924910222718682956
49. Maintz D,Seifarth H,Raupach R,et al. 64-slice multidetector coronary CT angiography: in vitro evaluation of 68 different stentsEuropean RadiologyYear: 20061648188262-s2.0-3364490989816333623
50. Mahnken AH,Seyfarth T,Flohr T,et al. Flat-panel detector computed tomography for the assessment of coronary artery stents: phantom study in comparison with 16-slice spiral computed tomographyInvestigative RadiologyYear: 20054018132-s2.0-1114434039315597014
51. Ionescu M,Metcalfe RW,Cody D,Alvarado MVY,Hipp J,Benndorf G. Spatial resolution limits of multislice computed tomography (MS-CT), C-arm-CT, and flat panel-CT (FP-CT) compared to MicroCT for visualization of a small metallic stentAcademic RadiologyYear: 20111878668752-s2.0-7995880503921669352
52. Mahnken AH,Mühlenbruch G,Seyfarth T,et al. 64-slice computed tomography assessment of coronary artery stents: a phantom studyActa RadiologicaYear: 200647136422-s2.0-3174444560016498931
53. Boll DT,Merkle EM,Paulson EK,Fleiter TR. Coronary stent patency: dual-energy multidetector CT assessment in a pilot study with anthropomorphic phantomRadiologyYear: 200824736876952-s2.0-4514912831918424688
54. Van Gompel G,Van Slambrouck K,Defrise M,et al. Iterative correction of beam hardening artifacts in CTMedical PhysicsYear: 2011381S36S492-s2.0-7996090532121978116
55. Seifarth H,Raupach R,Schaller S,et al. Assessment of coronary artery stents using 16-slice MDCT angiography: evaluation of a dedicated reconstruction kernel and a noise reduction filterEuropean RadiologyYear: 20051547217262-s2.0-1704443429915711845
56. Min JK,Swaminathan RV,Vass M,Gallagher S,Weinsaft JW. High-definition multidetector computed tomography for evaluation of coronary artery stents: comparison to standard-definition 64-detector row computed tomographyJournal of Cardiovascular Computed TomographyYear: 2009342462512-s2.0-6764939177619577213
57. Groen JM,Greuter MJW,Van Ooijen PMA,Willems TP,Oudkerk M. Initial results on visualization of coronary artery stents at multiple heart rates on a moving heart phantom using 64-MDCTJournal of Computer Assisted TomographyYear: 20063058128172-s2.0-3374857767416954935
58. Groen JM,Greuter MJW,van Ooijen PMA,Oudkerk M. A new approach to the assessment of lumen visibility of coronary artery stent at various heart rates using 64-slice MDCTEuropean RadiologyYear: 2007177187918842-s2.0-3425035037117429648
59. Seifarth H,Özgün M,Raupach R,et al. 64-Versus 16-slice CT angiography for coronary artery stent assessment: in vitro experienceInvestigative RadiologyYear: 200641122272-s2.0-3364506432316355036
60. Oncel D,Oncel G,Tastan A,Tamci B. Evaluation of coronary stent patency and in-stent restenosis with dual-source CT coronary angiography without heart rate controlAmerican Journal of RoentgenologyYear: 2008191156632-s2.0-4684909760418562725
61. Yang WJ,Chen KM,Pang LF,et al. High-definition computed tomography for coronary artery stent imaging: a phantom studyKorean Journal of RadiologyYear: 201213202622247632
62. Hamon M,Champ-Rigot L,Morello R,Riddell JW,Hamon M. Diagnostic accuracy of in-stent coronary restenosis detection with multislice spiral computed tomography: a meta-analysisEuropean RadiologyYear: 20081822172252-s2.0-3904913530217763854
63. Rixe J,Achenbach S,Ropers D,et al. Assessment of coronary artery stent restenosis by 64-slice multi-detector computed tomographyEuropean Heart JournalYear: 20062721256725722-s2.0-3375034975117035252
64. Van Mieghem CAG,Cademartiri F,Mollet NR,et al. Multislice spiral computed tomography for the evaluation of stent patency after left main coronary artery stenting: a comparison with conventional coronary angiography and intravascular ultrasoundCirculationYear: 200611476456532-s2.0-3374742870216894038
65. Rist C,von Ziegler F,Nikolaou K,et al. Assessment of coronary artery stent patency and restenosis using 64-slice computed tomographyAcademic RadiologyYear: 20061312146514732-s2.0-3375134228517138114
66. Oncel D,Oncel G,Tastan A. Effectiveness of dual-source CT coronary angiography for the evaluation of coronary artery disease in patients with atrial fibrillation: initial experienceRadiologyYear: 200724537037112-s2.0-3624901492518024451
67. Cademartiri F,Schuijf JD,Pugliese F,et al. Usefulness of 64-slice multislice computed tomography coronary angiography to assess in-stent restenosisJournal of the American College of CardiologyYear: 20074922220422102-s2.0-3424970843217543641
68. Ehara M,Kawai M,Surmely JF,et al. Diagnostic accuracy of coronary in-stent restenosis using 64-slice computed tomography: comparison with invasive coronary angiographyJournal of the American College of CardiologyYear: 20074999519592-s2.0-3384728292317336718
69. Carrabba N,Bamoshmoosh M,Carusi LM,et al. Usefulness of 64-slice multidetector computed tomography for detecting drug eluting in-stent restenosisAmerican Journal of CardiologyYear: 200710012175417582-s2.0-3684901086518082521
70. Das KM,El-Menyar AA,Salam AM,et al. Contrast-enhanced 64-section coronary multidetector CT angiography versus conventional coronary angiography for stent assessmentRadiologyYear: 200724524244322-s2.0-3534899657417890354
71. Schuijf JD,Pundziute G,Jukema JW,et al. Evaluation of patients with previous coronary stent implantation with 64-section CTRadiologyYear: 200724524164232-s2.0-3534893910817890353
72. Carbone I,Francone M,Algeri E,et al. Non-invasive evaluation of coronary artery stent patency with retrospectively ECG-gated 64-slice CT angiographyEuropean RadiologyYear: 20081822342432-s2.0-3904914017317929024
73. Manghat N,Van Lingen R,Hewson P,et al. Usefulness of 64-detector row computed tomography for evaluation of intracoronary stents in symptomatic patients with suspected in-stent restenosisAmerican Journal of CardiologyYear: 200810111156715732-s2.0-4354910041818489934
74. Hecht HS,Zaric M,Jelnin V,Lubarsky L,Prakash M,Roubin G. Usefulness of 64-detector computed tomographic angiography for diagnosing in-stent restenosis in native coronary arteriesAmerican Journal of CardiologyYear: 200810168208242-s2.0-4014909637018328847
75. Nakamura K,Funabashi N,Uehara M,et al. Impairment factors for evaluating the patency of drug-eluting stents and bare metal stents in coronary arteries by 64-slice computed tomography versus conventional coronary angiographyInternational Journal of CardiologyYear: 200813033493562-s2.0-5554909311718180050
76. Pontone G,Andreini D,Bartorelli AL,et al. Diagnostic accuracy of coronary computed tomography angiography: a comparison between prospective and retrospective electrocardiogram triggeringJournal of the American College of CardiologyYear: 20095443463552-s2.0-6765007005519608033
77. Haraldsdottir S,Gudnason T,Sigurdsson AF,et al. Diagnostic accuracy of 64-slice multidetector CT for detection of in-stent restenosis in an unselected, consecutive patient populationEuropean Journal of RadiologyYear: 20107621881942-s2.0-7814935888419570632
78. Papini GDE,Casolo F,Di Leo G,et al. In vivo assessment of coronary stents with 64-row multidetector computed tomography: analysis of metal artifactsJournal of Computer Assisted TomographyYear: 20103469219262-s2.0-7865047183321084910
79. Abdelkarim MJ,Ahmadi N,Gopal A,Hamirani Y,Karlsberg RP,Budoff MJ. Noninvasive quantitative evaluation of coronary artery stent patency using 64-row multidetector computed tomographyJournal of Cardiovascular Computed TomographyYear: 20104129372-s2.0-7624908428220159625
80. Wykrzykowska JJ,Arbab-Zadeh A,Godoy G,et al. Assessment of in-stent restenosis using 64-MDCT: analysis of the CORE-64 multicenter international trialAmerican Journal of RoentgenologyYear: 2010194185922-s2.0-7474910373220028909
81. Andreini D,Pontone G,Bartorelli AL,et al. High diagnostic accuracy of prospective ECG-gating 64-slice computed tomography coronary angiography for the detection of in-stent restenosis: In-stent restenosis assessment by low-dose MDCTEuropean RadiologyYear: 2011217143014382-s2.0-7995937689421331594
82. Zhao J,Zheng LL,Yang Y. Evaluation of coronary artery in-stent patency using 64-slice computed tomographyCoronary Artery DiseaseYear: 20112254055221959714
83. Zhang J,Li M,Lu Z,Hang J,Pan J,Sun L. In vivo evaluation of stent patency by 64-slice multidetector CT coronary angiography: shall we do it or not?International Journal of Cardiovascular ImagingYear: 2012286516582-s2.0-7995320661621461883
84. Carrabba N,Schuijf JD,De Graaf FR,et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography for the detection of in-stent restenosis: a meta-analysisJournal of Nuclear CardiologyYear: 20101734704782-s2.0-7795332264520379863
85. Kumbhani DJ,Ingelmo CP,Schoenhagen P,Curtin RJ,Flamm SD,Desai MY. Meta-analysis of diagnostic efficacy of 64-slice computed tomography in the evaluation of coronary in-stent restenosisAmerican Journal of CardiologyYear: 200910312167516812-s2.0-6764944083019539075
86. Sun Z,Almutairi AMD. Diagnostic accuracy of 64 multislice CT angiography in the assessment of coronary in-stent restenosis: a meta-analysisEuropean Journal of RadiologyYear: 20107322662732-s2.0-7634909069319056191
87. Vanhoenacker PK,Decramer I,Bladt O,et al. Multidetector computed tomography angiography for assessment of in-stent restenosis: meta-analysis of diagnostic performanceBMC Medical ImagingYear: 20088p. 142-s2.0-51649108854
88. Pugliese F,Weustink AC,Van Mieghem C,et al. Dual source coronary computed tomography angiography for detecting in-stent restenosisHeartYear: 20089478488542-s2.0-4624910531117881474
89. Pflederer T,Marwan M,Renz A,et al. Noninvasive assessment of coronary in-stent restenosis by dual-source computed tomographyAmerican Journal of CardiologyYear: 200910368128172-s2.0-6134911275019268737
90. Zhao L,Zhang Z,Fan Z,Yang L,Du J. Prospective versus retrospective ECG gating for dual source CT of the coronary stent: comparison of image quality, accuracy, and radiation doseEuropean Journal of RadiologyYear: 20117734364422-s2.0-7995298464819783395
91. Veselka J,Cadova P,Tomasov P,Theodor A,Zemanek D. Dual-source CT angiography for detection and quantification of in-stent restenosis in the left main coronary artery: comparison with intracoronary ultrasound and coronary angiographyJournal of Invasive CardiologyYear: 20112346046422045078
92. Zhang X,Yang L,Wu J,et al. Diagnostic accuracy and its affecting factors of dual-source CT for assessment of coronary stents patency and in-stent restenosisChinese Medical JournalYear: 20121251936194022884057
93. De Graaf FR,Schuijf JD,Van Velzen JE,et al. Diagnostic accuracy of 320-row multidetector computed tomography coronary angiography to noninvasively assess in-stent restenosisInvestigative RadiologyYear: 20104563313402-s2.0-7795249694220404736
94. Kubo T,Matsuo Y,Ino Y,et al. Diagnostic accuracy of CT angiography to assess coronary stent thrombosis as determined by intravascular OCTJACC Cardiovasc ImagingYear: 201141040104321920343
95. Taylor AJ,Cerqueira M,Hodgson JM,et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic ResonanceCirculationYear: 2010122e525e55520975004
96. Lee SH,Park JS,Shin DG,et al. Frequency of stent fracture as a cause of coronary restenosis after sirolimus-eluting stent implantationAmerican Journal of CardiologyYear: 200710046276302-s2.0-3454766911217697818
97. Pang JH,Kim D,Beohar N,Meyers SN,Lloyd-Jones D,Yaghmai V. Detection of stent fractures: a comparison of 64-slice CT, conventional cine-angiography, and intravascular ultrasonographyAcademic RadiologyYear: 20091641241719268852
98. Lim HB,Hur G,Kim SY,et al. Coronary stent fracture: detection with 64-section multidetector CT angiography in patients and in vitroRadiologyYear: 200824938108192-s2.0-5814919670619011182
99. Hecht HS,Polena S,Jelnin V,et al. Stent gap by 64-detector computed tomographic angiography relationship to in-stent restenosis, fracture, and overlap failureJournal of the American College of CardiologyYear: 20095421194919592-s2.0-7035070866819909876
100. Budoff MJ,Achenbach S,Blumenthal RS,et al. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical CardiologyCirculationYear: 200611416176117912-s2.0-3375020625317015792
101. Mark DB,Berman DS,Budoff MJ,et al. ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: a report of the American College of Cardiology Foundation Task Force on Expert Consensus DocumentsJournal of the American College of CardiologyYear: 20105523266326992-s2.0-7795286963220513611
102. Achenbach S,Goroll T,Seltmann M,et al. Detection of coronary artery stenoses by low-dose, prospectively ECG-triggered, high-pitch spiral coronary CT angiographyJACC Cardiovascular ImagingYear: 2011443283372-s2.0-7995456225221492807
103. Wolf F,Leschka S,Loewe C,et al. Coronary artery stent imaging with 128-slice dual-source CT using high-pitch spiral acquisition in a cardiac phantom: comparison with the sequential and low-pitch spiral modeEuropean RadiologyYear: 2010209208420912-s2.0-7795794334720397019
104. Magalhães TA,Cury RC,Pereira AC,et al. Additional value of dipyridamole stress myocardial perfusion by 64-row computed tomography in patients with coronary stentsJournal of Cardiovascular Computed TomographyYear: 2011544945822146504
105. Serruys PW,Onuma Y,Ormiston JA,et al. Evaluation of the second generation of a bioresorbable everolimus drug-eluting vascular scaffold for treatment of de novo coronary artery stenosis: six-month clinical and imaging outcomesCirculationYear: 201158157815882-s2.0-78650108611

Article Categories:
  • Review Article

Previous Document:  Diagnostic value of exhaled carbon monoxide as an early marker of exacerbation in children with chro...
Next Document:  Recurrent syncope in patients with carotid sinus hypersensitivity.