Surveillance imaging after intracranial stent implantation: non-invasive imaging compared with digital subtraction angiography. J Neurointerv Surg 2013 Jul;5(4):361-5
Date
05/30/2012Pubmed ID
22641863DOI
10.1136/neurintsurg-2012-010341Scopus ID
2-s2.0-84879327118 (requires institutional sign-in at Scopus site) 11 CitationsAbstract
BACKGROUND: Digital subtraction angiography (DSA) is the gold standard imaging for detection of in-stent restenosis (ISR) but there is limited literature on optimal non-invasive surveillance imaging. In this study, the ability of CT angiography (CTA) and MR angiography (MRA) compared with DSA in recognizing ISR was assessed.
METHODS: A single center database of patients treated with stent implantation for ICAD was accessed. All patients who underwent follow-up imaging with DSA paired with either MRA or CTA within 30 days were included. Two angiography readers and two non-invasive imaging readers measured restenosis with a submillimeter digital caliper. ISR was categorized as: none/minimal, mild (<50%), moderate (≥50-70%) or severe (≥70%). Analysis was performed with weighted κ statistics.
RESULTS: 17 cases of individual stents that underwent surveillance imaging with paired DSA and CTA and five stents with paired DSA and MRA were identified. Of those undergoing DSA and CTA, inter-reader agreement produced κ=0.68 (95% CI 0.40 to 0.95) for DSA and κ=0.75 (95% CI 0.55 to 0.95) for CTA. Agreement across CTA and DSA was κ=0.36 (95% CI 0.26 to 0.52). Of those undergoing DSA and MRA, inter-reader agreement produced κ=0.71 (95% CI 0.27 to 1.00) for DSA and κ=1.00 (95% CI 1.00 to 1.00) for MRA. Agreement across MRA and DSA was κ=0.34 (95% CI 0.18 to 0.51).
CONCLUSIONS: Good inter-reader agreement exists within DSA, CTA and MRA. However, when comparing non-invasive imaging (CTA and MRA) with DSA, only fair agreement exists. These data suggest that CTA and MRA are not comparable to DSA for evaluation of ISR.
Author List
Golshani B, Lazzaro MA, Raslau F, Darkhabani Z, Baruah D, Eastwood D, Fitzsimmons BF, Zaidat OOAuthor
Marc A. Lazzaro MD Associate Professor in the Neurology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Angiography, Digital Subtraction
Cerebral Angiography
Female
Follow-Up Studies
Humans
Intracranial Aneurysm
Magnetic Resonance Angiography
Male
Middle Aged
Stents
Tomography, X-Ray Computed
Young Adult