Stress-echocardiography with dobutamine and transesophageal atrial pacing in diagnosis of late coronary stent restenosis

Abstract

To determine the diagnostic value of stress-echocardiography with combined agents in diagnosis of late coronary stent restenosis. 67 patients with symptoms of cardialgia aged from 38 to 56, who underwent coronary balloon angioplasty and stent implantation from 4 to 8 years ago, were included in the study. To determine coronary stent restenosis all patients underwent stress-echocardiography (stress-echoCG) in the protocol dobutamine/ transesophageal atrial pacing (TEAP) and follow up coronary angiography (CAG). The results of stress-echoCG from 62 patients can suggest the presence of restenosis of stent-implanted artery, in 5 cases - stenosis of noninvolved coronary arteries, that was confirmed during CAG. Opinion of coronary stent restenosis was based on detection of local contractility impairment zones in vascular depended region of stent-implanted artery. CAG revealed restenosis of coronary stent >70.0 % in 28 patients, from 40.0 % to 70.0 % in 28 patients. In 6 cases de novo segmental stenosis in stent-implanted artery were observed, which localized distal or proximal to intact stent. In 3 patients zones of local contractility impairment revealed by stress-echoCG corresponds with stenosis of noninvolved circumflex arteries in 2 patients, in 3 patients - left anterior descending artery stenosis. Accuracy, sensitivity and specificity of stress-echoCG in diagnosis of coronary stents restenosis as well as noninvolved coronary arteries stenosis appeared to be correspondently 91.0 %, 90.3 % and 100 %. Stress-echoCG is a high informative method of early topical diagnosis of coronary stents restenosis as well as noninvolved coronary arteries stenosis. Early diagnosis of coronary stents restenosis permit to produce low invasive endovascular intervention.