Specific calcium deposition on pre-procedural CCTA at the time of percutaneous coronary intervention predicts in-stent restenosis in symptomatic patients

Purpose

To characterize preprocedural coronary atherosclerotic lesions derived from CCTA and assess their association with in-stent restenosis (ISR) after percutaneous coronary intervention (PCI).

Materials and methods

This retrospective cohort-study included patients who underwent CCTA for suspected coronary artery disease, subsequent index angiography including PCI and surveillance angiography within 6–8 months after the index procedure. We performed a plaque analysis of culprit lesions on CCTA using a dedicated plaque analysis software including assessment of the surrounding pericoronary fat attenuation index (FAI) and compared findings between lesions with and without ISR at surveillance angiography after stenting.

Results

Overall 278 coronary lesions in 209 patients were included. Of these lesions, 43 (15.5 ​%) had ISR at surveillance angiography after stenting while 235 (84.5 ​%) did not. Likewise, plaque composition such as volume of calcification [129.8 mm³ (83.3–212.6) vs. 94.4 mm³ (60.4–160.5) p ​= ​0.06] and lipid-rich and fibrous plaque volume [38.4 mm³ (19.4–71.2) vs. 38.0 mm³ (14.0–59.1), p ​= ​0.11 and 50.4 mm³ (26.1–77.6) vs. 42.1 mm³ (31.1–60.3), p ​= ​0.16] between lesion with and without ISR were not statistically significant. However lesions associated with ISR were more eccentric (n ​= ​37, 86.0 ​% versus n ​= ​159, 67,7 ​%; p ​= ​0.03) and more frequently demonstrated calcified portions on opposite sides on the vessel wall on cross-sectional datasets (n ​= ​24, 55.8 ​% versus n ​= ​55, 23.4 ​%, p ​= ​0.001). FAI_lesion was significantly different in lesions with ISR as compared to those without ISR [-76.5 (−80.1 to −73.6) vs. −80.9 (−88.9 to −74.0), p ​= ​0.02]. There was no difference with respect to FAI_RCA between the two groups [-77.4 (−81.9 to −75.6) vs. −78.5 (−86.0 to −71.0), p ​= ​0.41].

Conclusion

Coronary lesions associated with ISR at surveillance angiography demonstrated differences in the arrangement of calcified portions as well as an increased lesion-specific pericoronary fat attenuation index at baseline CCTA. This latter finding suggests that perivascular inflammation at baseline may play a major role in the development of in-stent restenosis.