Diagnostic performance of CCTA and CTP imaging for clinically suspected in-stent restenosis: A meta-analysis

Dahdal, JorgeJukema, Ruurt A.Remmelzwaal, SharonRaijmakers, Pieter G.Harst, Pim van derGuglielmo, MarcoCramer, Maarten J.Chamuleau, Steven A.J.Diemen, Pepijn A. vanKnaapen, PaulDanad, Ibrahim2025-01-272025-01-272025Jorge Dahdal, Ruurt A. Jukema, Sharon Remmelzwaal, Pieter G. Raijmakers, Pim van der Harst, Marco Guglielmo, Maarten J. Cramer, Steven A.J. Chamuleau, Pepijn A. van Diemen, Paul Knaapen, Ibrahim Danad, Diagnostic performance of CCTA and CTP imaging for clinically suspected in-stent restenosis: A meta-analysis, Journal of Cardiovascular Computed Tomography, Volume 19, Issue 2, 2025, Pages 183-190,ISSN 1934-5925, https://doi.org/10.1016/j.jcct.2024.10.014https://hdl.handle.net/11447/9714Aims: The objective of this study is to conduct a meta-analysis to assess the diagnostic performance of Coronary Computed Tomography Angiography (CCTA) and a hybrid approach that incorporates Computed Tomography Perfusion (CTP) in addition to CCTA (CCTA þ CTP) for the detection of in-stent restenosis (ISR), as defined by angiography. Methods: A comprehensive search of articles identified 18,513 studies. After removing duplicates, title/abstract screening, and full-text review, 17 CCTA and 3 CCTA þ CTP studies were included. Only studies using 64-slices multidetector computed tomography (CT) were considered eligible. Results: The per-patient ISR prevalence was 43 %, with 92 % of stents fully interpretable with CCTA. Meta-analysis exhibited a per-stent CCTA (n ¼ 2674) sensitivity of 90 % (95 % CI; 84–94 %), specificity of 89 % (95 % CI; 86–92 %), positive likelihood ratio of 7.17 (95 % CI; 5.24–9.61), negative likelihood ratio of 0.17 (95 % CI; 0.10–0.25), and diagnostic odds ratio of 45.7 (95 % CI; 22.71–82.43). Additional sensitivity analyses revealed no influence of stent diameter or strut thickness on the diagnostic yield of CCTA. The per-stent diagnostic performance of CCTA þ CTP (n ¼ 752) did not show differences compared to CCTA. Conclusions: With currently utilized scanners, CCTA and CCTA þ CTP demonstrated high diagnostic performance for in-stent restenosis evaluation. Consequently, a history of previous stent implantation should not be an argument to preclude using these methods in clinically suspected patients.8 p.enCCTACTPCADPCIStentsDiagnostic performance of CCTA and CTP imaging for clinically suspected in-stent restenosis: A meta-analysisArticlehttps://doi.org/10.1016/j.jcct.2024.10.014