Koroner stent kırığı, trombozu ve restenozunun BT görünümü

Özet

Koroner stentli hastada yeni göğüs ağrısı veya iskemi şüphesinde stent lümeninin açıklığı ve olası mekanik hasar değerlendirilir. Koroner BT anjiyografi, stent içi kontrastı ve stent boyunca lümen daralmasını doğrudan gösterebilir; değerlendirme stent çapı, strut yapısı, hareket ve kalsiyum artefaktlarından etkilenir. Koroner BT anjiyografi stent lümenini değerlendirmek için kullanılır ancak metal strutların blooming artefaktı, kardiyak hareket ve yoğun kalsifikasyonlar nedeniyle lümen daralmasının gerçek derecesi gizlenebilir veya abartılabilir. Stent lümeni artefakt nedeniyle seçilemiyorsa BT'de kesin açıklık ya da oklüzyon hükmü verilmemelidir.

Faz ve pencere

BTA tanısal

EKG eşlemeli koroner arteriyel fazda, ince kesitlerde stent içindeki iyotlu kontrast sütunu izlenir; fokal düşük atenüasyonlu lümen daralması restenoz/trombüsü düşündürebilir. Metal strut blooming'i, parsiyel hacim ve kardiyak hareket artefaktı açık lümeni örtebilir ya da yapay daralma oluşturabilir.

Önerilen pencereler: Anjiyo (G 600 / M 150), Mediasten (G 350 / M 50).

BT bulguları

• İn-stent restenoz — stent içinde kontrastlı lümenin fokal veya yaygın daralması; kısa eksen kesitleri ve damar boyunca CPR ile doğrulanır.
• İn-stent trombüs — stent lümenini kısmen ya da tamamen dolduran düşük atenüasyonlu materyal ve azalmış distal opaklaşma.
• Tam oklüzyon — stent içinde kontrast sütunu izlenmez; proksimal ve distal referans damar dolumu ile kollateraller ayrıca incelenir.
• Strut süreksizliği — stent halkalarının beklenen diziliminde kesinti, aralık veya ayrışma; komşu kesitlerde ve farklı düzlemlerde sürmesi kırık şüphesini artırır.
• Stent deformasyonu — lokal bükülme, ezilme veya üst üste binme görünümü, lümen şeklinin bozulmasıyla birlikte olabilir.
• Stent ucu darlığı — daralma metal segmentin içinde değil, proksimal ya da distal kenarın komşuluğunda yer alır.
• Distal miyokard bulgusu — ilgili koroner dağılımda gecikmiş veya azalmış miyokard kontrastlanması görülebilir; tek fazlı koroner CTA perfüzyon testi değildir.

Ölçütler ve sınıflamalar

Anlamlı koroner in-stent restenoz

Lümen çapında ≥%50 daralma

Mehran in-stent restenoz patern sınıflaması

Mehran sınıflaması, stent içi restenozun örüntülerini tanımlamak amacıyla kullanılır ve CCTA’daki uygulaması stent lümeninin seçilebilirliğine bağlıdır. CCTA’da morfolojik patern olarak uygulanır; değerlendirme stent lümeninin seçilebilirliğine bağlıdır.

Normalde

Aynı düzeyde açık koroner stentte kontrast sütunu metal strutların arasında kesintisizdir ve stent öncesi-sonrası doğal koroner lümenle devamlılık gösterir. Karşılaştırmada stentin kısa eksenindeki rezidüel lümeni, uzun eksendeki daralma uzunluğunu ve stent dışındaki komşu koroner segmentleri birlikte inceleyin.

Ayırıcı tanı

Blooming artefaktı

parlak strut kenarları gerçek boyutundan kalın görünerek sanal lümen daralması oluşturur; farklı rekonstrüksiyon ve ortogonal düzlemlerde kıyasla.

Kardiyak hareket artefaktı

stent konturu veya lümen çiftlenmiş/bulanık görünür; komşu hareketli koroner segmentlerde de hizalanma bozulur.

Stent kenarı plağı

daralma metal stent içinde değil, stent ucunun hemen öncesinde ya da sonrasında yerleşir.

Koroner kalsifiye plak

damar duvarında çok yüksek atenüasyonlu odak lümeni örter; komşu stent strutlarından bağımsız izlenir.

Akım kaynaklı yalancı dolum kusurunu değerlendirirken, lümen darlığının derecesini yakındaki darlık olmayan koroner segmentlerle karşılaştırın.

Tuzaklar

• Distal koroner opaklaşma tek başına stent açıklığını göstermez; oklüde stentte de kollateral akım görülebilir.
• Strut blooming'ini gerçek restenozla eşitleme; lümeni stent eksenine dik kesitlerde ve farklı rekonstrüksiyonlarda kontrol et.
• Tek kesitte halkaların seçilememesini kırık kabul etme; hareket ve metal artefaktı aynı görüntüyü taklit edebilir, süreksizliği ardışık görüntülerde doğrula.
• Stent lümeni değerlendirilemiyorsa stenoz derecesini kesin raporlama; artefakt nedeniyle tanısal sınır açıkça belirtilmelidir.

Kendini dene

1. Koroner CTA'da stent kısa ekseninde metal strutlar arasında kontrastlı lümen çapı belirgin daralmış. Hangi eşik anlamlı restenozu tanımlar?

   • ≥%50 çap daralması
   • >%10 çap daralması
   • Yalnız kalsiyum skoru
   • Stent uzunluğunda artış
   Cevabı göster

   ≥%50 çap daralması. Anlamlı stenoz derecesi genellikle komşu sağlıklı segmentlerle karşılaştırılarak yarı-nicel olarak belirlenir; CAD-RADS 2.0'a göre 50-69% orta, 70-99% şiddetli stenoz kategorilerindedir. Küçük düzensizlik tek başına anlamlı stenoz değildir; kalsiyum skoru ve stent uzunluğu lümen daralmasının yerine geçmez.

2. Stent çevresindeki parlak metal kenarları kalın, fakat farklı düzlemde merkezde kontrastlı lümen korunmuş. En olası açıklama nedir?

   • Blooming artefaktı
   • Tam stent trombozu
   • Koroner diseksiyon
   • Distal emboli
   Cevabı göster

   Blooming artefaktı. Metal strut blooming'i kenarları olduğundan kalın gösterip rezidüel lümeni daraltabilir; ortogonal düzlemde devam eden merkez kontrastı bunu destekler. Tam trombozda lümen kontrastı kaybolur; diseksiyonda flap, embolide ise stent dışı distal damar tıkanıklığı aranır.

İlgili konular

• Vasküler stent/greft oklüzyonu, tromboz ve restenoz

Kaynaklar

Bu sayfadaki 41 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 5 cümle bu karşılaştırmada düzeltildi (2026-10-08).

1. Coronary computed tomography angiography for clinical practicepmc.ncbi.nlm.nih.gov
2. Stent Fracture: How Frequently Is It Recognized?pmc.ncbi.nlm.nih.gov
3. Coronary Artery Calcification: From Molecular Mechanisms to Interventional Strategiespmc.ncbi.nlm.nih.gov
4. Coronary Calcified Nodules: From Pathological Definitions to Intravascular Imaging- and Morphology-Guided PCIpmc.ncbi.nlm.nih.gov
5. Plaque Prolapse in Carotid Artery Stenting: Mechanisms, Imaging and Device-Based Preventionpmc.ncbi.nlm.nih.gov
6. Advances in the development of biodegradable coronary stents: A translational perspective.pubmed.ncbi.nlm.nih.gov
7. Integrating Invasive and Noninvasive Imaging for Coronary Atherosclerosis: A Systematic Review With Pragmatic Algorithms From Anatomy to Physiology.pubmed.ncbi.nlm.nih.gov
8. Delayed Chimney Stent Fracture After Transcatheter Aortic Valve Replacement.pubmed.ncbi.nlm.nih.gov
9. First Diagonal to Left Ventricle Fistula With LAD Collateral Flow: An Unusual Coronary Detour.pubmed.ncbi.nlm.nih.gov
10. Safety of pulsed-field ablation combined with IVUS-guided pulmonary vein stenting during atrial fibrillation ablation: a case report.pubmed.ncbi.nlm.nih.gov
11. Study Protocol for the Evaluation of Morphologic and Imaging Remodeling of Atherosclerotic Plaque Following Intravascular Lithotripsy in Peripheral Artery Disease.pubmed.ncbi.nlm.nih.gov
12. CT-Centered Multimodality Imaging of Arterial Wall Fragility in Acute Aortic Syndromes: A Narrative Review of Imaging Markers and Clinical Implications.pubmed.ncbi.nlm.nih.gov
13. Photon-Counting Computed Tomography for In-Stent Occlusion: Lumen Visualization and Myocardial Viability.pubmed.ncbi.nlm.nih.gov
14. Coronary Artery Ectasia and Aneurysm: Benign Variant or High-Risk Substrate in Need of Tailored Treatment?pubmed.ncbi.nlm.nih.gov
15. Kounis Syndrome in the Modern Era: A Comprehensive Review of Allergic Acute Coronary Syndromes.pubmed.ncbi.nlm.nih.gov
16. Photon-counting computed tomography in coronary artery bypass grafting planning and follow-up: a narrative review of a high-resolution adjunct to invasive angiography.pubmed.ncbi.nlm.nih.gov
17. Advanced quantitative CT for coronary artery disease: integrating stenosis quantification, plaque quantification, and fractional flow reserve-CT.pubmed.ncbi.nlm.nih.gov
18. Artificial Intelligence-Assisted Intravascular Imaging in Percutaneous Coronary Intervention: Current Status and Advances.pubmed.ncbi.nlm.nih.gov
19. Cardiac CT for electrophysiological interventions.pubmed.ncbi.nlm.nih.gov
20. Hunting for a coronary artery disease diagnosis in asymptomatic patients with diabetes mellitus: if, how and when.pubmed.ncbi.nlm.nih.gov
21. Serum marker and CT characteristics of coronary calcified nodule assessed by intravascular ultrasound.pubmed.ncbi.nlm.nih.gov
22. Clinical benefits and current challenges of photon-counting detector CT in vascular imaging.pubmed.ncbi.nlm.nih.gov
23. Understanding Photon-Counting CT: Physics, Detector Technology, and Image Reconstructions.pubmed.ncbi.nlm.nih.gov
24. Ultra-High-Resolution Photon-Counting CT Angiography for Noninvasive Detection of Neurovascular In-Stent Restenosis.pubmed.ncbi.nlm.nih.gov
25. Coronary Computed Tomography Angiography for the Diagnosis and Revascularization Guidance of Coronary Bifurcation Lesions: A Contemporary Review.pubmed.ncbi.nlm.nih.gov
26. Intravascular ultrasound-guided percutaneous treatment of late-presenting left anterior descending artery compression after penetrating cardiac trauma in a young adult: a case report.pubmed.ncbi.nlm.nih.gov
27. Association of Elevated Lipoprotein(a) levels with vulnerable plaque features assessed by multimodality coronary imaging in patients with coronary artery disease: A systematic review and Meta-analysis.pubmed.ncbi.nlm.nih.gov
28. Percutaneous coronary intervention in cardiac allograft vasculopathy: From lesion selection to longitudinal graft management.pubmed.ncbi.nlm.nih.gov
29. Early prosthetic valve endocarditis presenting as acute right coronary artery occlusion 1 month after aortic valve replacement: a case report.pubmed.ncbi.nlm.nih.gov
30. Severe Acute Pancreatitis With Simultaneous Anterior ST-Elevation Myocardial Infarction in a 28-Year-Old: Navigating Conflicting Emergencies.pubmed.ncbi.nlm.nih.gov
31. Feasibility and long-term outcomes of recanalization for De novo small vessel chronic total occlusions.pubmed.ncbi.nlm.nih.gov
32. Comparative analysis of the postoperative effectiveness of different splenic artery aneurysm embolization techniques.pubmed.ncbi.nlm.nih.gov
33. From intravascular imaging to adaptive vascular care: intelligent photonics and digital twins in panvascular disease.pubmed.ncbi.nlm.nih.gov
34. The Role of Calcified Nodules in Acute Coronary Syndrome: Diagnosis and Management.pubmed.ncbi.nlm.nih.gov
35. Infective endocarditis surgery using conventional prosthetic valves versus homograft: the IESCOPO study protocol.pubmed.ncbi.nlm.nih.gov
36. Mechanically governed fracture resistance of biodegradable Zn-Cu alloy stents: Role of ring-length optimized structural design.pubmed.ncbi.nlm.nih.gov
37. Wearable and Implantable Soft Robots.pubmed.ncbi.nlm.nih.gov
38. Advanced Robotics for the Next-Generation of Cardiac Interventions.pubmed.ncbi.nlm.nih.gov
39. Beyond Angiography: Integrating Advanced Diagnostic Modalities in Coronary Stent Restenosis-a Systematic Review.pubmed.ncbi.nlm.nih.gov
40. Plaque Prolapse in Carotid Artery Stenting: Mechanisms, Imaging and Device-Based Prevention.pubmed.ncbi.nlm.nih.gov
41. Chronic draining xiphisternal fistula associated with fractured right coronary artery stent and transdiaphragmatic inflammatory extension: a multimodality imaging and surgical correlation.pubmed.ncbi.nlm.nih.gov
42. Acute inferior STEMI in a unique setting: case report on anomalous circumflex and multivessel coronary artery disease.pubmed.ncbi.nlm.nih.gov
43. Right ventricular thrombus following a left anterior descending infarction: a rare case report of a common culprit.pubmed.ncbi.nlm.nih.gov
44. Incidence, Timing and Associated Factors of In-Stent Restenosis after CASPER Placement: A Single-Center Retrospective Study.pubmed.ncbi.nlm.nih.gov
45. Paclitaxel-Coated Balloon for Coronary In-Stent Restenosis and De Novo Disease in Chinese Patients.pubmed.ncbi.nlm.nih.gov
46. Diagnostic Performance of Photon-Counting CT Angiography in Vascular Stenosis Assessment: A Systematic Review and Meta-Analysis.pubmed.ncbi.nlm.nih.gov
47. The Emerging Role of Computed Tomography Coronary Angiography in the Left Main Stem Percutaneous Coronary Intervention.pubmed.ncbi.nlm.nih.gov
48. Computational Analysis of Intravascular OCT Images for Future Clinical Support: A Comprehensive Review.pubmed.ncbi.nlm.nih.gov
49. Definitions and standardized endpoints for the use of drug-coated balloon in coronary artery disease: consensus document of the Drug Coated Balloon Academic Research Consortium.pubmed.ncbi.nlm.nih.gov
50. Beyond Angiography: Cardiac CT for Planning Complex PCI in Calcified Coronary Lesions.pubmed.ncbi.nlm.nih.gov
51. The Initial Diagnostic Approach to Adult Congenital Heart Disease: A Practical Imaging Pathway for General Cardiologists and Cardiac Imagers.pubmed.ncbi.nlm.nih.gov
52. Red Cell Distribution Width-Standard Deviation and the Severity of In-Stent Restenosis: Associations with Angiographic Stenosis Burden and Mehran Classification.pubmed.ncbi.nlm.nih.gov
53. Role of Intracoronary Imaging in Percutaneous Coronary Intervention for In-Stent Restenosis: A Prospective Observational Study.pubmed.ncbi.nlm.nih.gov
54. Practical Management in Coronary In-Stent Restenosis: A Narrative Review.pubmed.ncbi.nlm.nih.gov
55. Intravascular imaging in coronary stent restenosis: Prevention, characterization, and management.pubmed.ncbi.nlm.nih.gov
56. Photon-Counting CT in Cardiovascular Imaging: Clinical Applications.pubmed.ncbi.nlm.nih.gov
57. Radiation dose optimization in coronary CT angiography clinical application of absolute phase gating in patients with atrial fibrillation.pubmed.ncbi.nlm.nih.gov
58. Computed Tomography Imaging of Thoracic Aortic Surgery: Distinguishing Life-Saving Repairs from Life-Threatening Complications.pubmed.ncbi.nlm.nih.gov
59. Society for Cardiovascular Magnetic Resonance 2024 Cases of SCMR case series.pubmed.ncbi.nlm.nih.gov
60. Clinical Impact of CT-Based FFR in Everyday Cardiology: Bridging Computation and Decision-Making.pubmed.ncbi.nlm.nih.gov
61. Utility of artificial intelligence in predicting clinical outcomes of angiographic procedures: a comprehensive scoping review.pubmed.ncbi.nlm.nih.gov
62. Calcified coronary artery disease: Mechanisms, risk factors and clinical consequences.pubmed.ncbi.nlm.nih.gov
63. Identification of coronary calcified nodules on noninvasive coronary CT: A two-case report with intravascular imaging correlation.pubmed.ncbi.nlm.nih.gov
64. Coronary CT Angiography in PCI Planning: Advances, Clinical Applications, and Challenges.pubmed.ncbi.nlm.nih.gov
65. Clinical Utility and Limitations of Photon-Counting Detector CTA in the Follow-Up of Flow Diverter Stent.pubmed.ncbi.nlm.nih.gov
66. Transcatheter Closure of Patent Ductus Arteriosus in Adults.pubmed.ncbi.nlm.nih.gov
67. Technical principles, benefits, challenges, and applications of photon counting computed tomography in coronary imaging: a narrative review.pubmed.ncbi.nlm.nih.gov
68. Cardiac CT blooming artifacts: clinical significance, root causes and potential solutions.pubmed.ncbi.nlm.nih.gov
69. Stent visualization methods to guide percutaneous coronary interventions and assess long-term patency.pubmed.ncbi.nlm.nih.gov
70. Spontaneous bacteremia and spontaneous bacterial peritonitis share similar prognosis in patients with cirrhosis: a cohort study.pubmed.ncbi.nlm.nih.gov
71. Technical advances and clinical impact of photon-counting computed tomography angiography for peripheral artery disease.pubmed.ncbi.nlm.nih.gov
72. From Electrocardiography to the Catheterization Laboratory: A Multimodal Artificial Intelligence Framework for Acute Coronary Syndrome Detection and Risk Stratification.pubmed.ncbi.nlm.nih.gov
73. Coronary CT Angiography for PCI Planning and Guidance: A Comprehensive Narrative Review.pubmed.ncbi.nlm.nih.gov
74. Hemodynamic Significance of APEXCT Coronary Angiography Combined With Dynamic CT Myocardial Perfusion Imaging in Assessing Restenosis After Coronary Stenting.pubmed.ncbi.nlm.nih.gov
75. Cardiac Computed Tomography in Structural Heart Interventions: From Preprocedural Planning to Procedural Strategy.pubmed.ncbi.nlm.nih.gov
76. Aortic Valve Leaflet Modification: A Working Group Position Statement on Best Practices and Step-by-Step Guide.pubmed.ncbi.nlm.nih.gov
77. Unveiling the Causes of Acute and Non-Acute Myocardial Ischemic Syndromes: The Role of Optical Coherence Tomography.pubmed.ncbi.nlm.nih.gov
78. CT angiography after 20 years: a transformation in cardiovascular disease characterization continues to advance.pubmed.ncbi.nlm.nih.gov
79. A review of the pathogenic mechanism and clinical management progress of in-stent calcification restenosis.pubmed.ncbi.nlm.nih.gov
80. Stent Undersizing and Malapposition: Mechanical Causes of Acute and Late Stent Failure.pubmed.ncbi.nlm.nih.gov
81. Lipoprotein(a) in Coronary Artery Disease and Aortic Stenosis: Pathophysiology, Clinical Impact, Interventional Implications and Emerging Targeted Therapies.pubmed.ncbi.nlm.nih.gov
82. Standards for quantitative assessments by coronary computed tomography angiography (CCTA): An expert consensus document of the society of cardiovascular computed tomography (SCCT).pubmed.ncbi.nlm.nih.gov
83. Exploring double low-dose CT technology for achieving coronary mixed reality radiation dose reduction: a preliminary study in coronary artery disease patients.pubmed.ncbi.nlm.nih.gov
84. Optical Coherence Tomography in Myocardial Infarction Management: Enhancing Precision in Percutaneous Coronary Intervention.pubmed.ncbi.nlm.nih.gov
85. Mechanisms of aortic dissection: From pathological changes to experimental and <i>in silico</i> models.pubmed.ncbi.nlm.nih.gov
86. Pictorial review: a step-by-step guide to coronary CT angiography with photon-counting detector CT.pubmed.ncbi.nlm.nih.gov
87. Comparison of GPT-4o With Human Performance in the Polish Vascular Surgery Specialty Examination.pubmed.ncbi.nlm.nih.gov
88. Predictive value of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio for in-stent restenosis after drug-eluting stent implantation in patients with coronary heart disease.pubmed.ncbi.nlm.nih.gov
89. Exercise After Coronary Stenting: Potential Effects on in-Stent Restenosis.pubmed.ncbi.nlm.nih.gov
90. Artificial Intelligence in Acute Neuroimaging Pathways: Diagnostic Accuracy, Workflow Performance, and Clinical Outcomes Across CT and MRI in Stroke and Trauma.pubmed.ncbi.nlm.nih.gov
91. Obesity and Cardiovascular Disease: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2026.pubmed.ncbi.nlm.nih.gov
92. Aortic Pseudoaneurysm Mimicking a Pulmonary Neoplasm in an 87-Year-Old Patient: The Challenge of the "Great Mimicker" in Emergency Medicine.pubmed.ncbi.nlm.nih.gov
93. CT Angiography of the Upper Extremities: Review of Acute Arterial Entities.pubmed.ncbi.nlm.nih.gov
94. Coronary computed tomography angiography for clinical practice.pubmed.ncbi.nlm.nih.gov
95. When Cancer Clots: An Extensive Radiologic Analysis of Cancer-Associated Thromboembolism.pubmed.ncbi.nlm.nih.gov
96. Multimodal imaging of acquired aortic diseases: clinical efficacy, comparative analysis, and future perspectives.pubmed.ncbi.nlm.nih.gov
97. Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia.pubmed.ncbi.nlm.nih.gov
98. Global vascular guidelines on the management of chronic limb-threatening ischemia.pubmed.ncbi.nlm.nih.gov
99. Long-term safety and effectiveness of the "OptEase" vena cava filter.pubmed.ncbi.nlm.nih.gov
100. Coronary Artery Calcification: From Molecular Mechanisms to Interventional Strategies.pubmed.ncbi.nlm.nih.gov
101. Coronary Calcified Nodules: From Pathological Definitions to Intravascular Imaging- and Morphology-Guided PCI.pubmed.ncbi.nlm.nih.gov
102. A terminator-inspired liquid metal stent for treating atherosclerotic vascular stenosis with precise vascular matching and magnetothermally regulated active degradation.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez. İçerik yapay zekâ destekli bir süreçle güncel literatüre göre cümle cümle kaynaklarla karşılaştırıldı, ancak uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.