title: Quantitative angiographic analysis of stent restenosis in the Scripps Coronary Radiation to Inhibit Intimal Proliferation Post Stenting (SCRIPPS) Trial.
abstract: To identify luminal dimension changes occurring within the stent alone and within the stent + margin segment, we reviewed the quantitative angiographic results obtained from the Scripps Coronary Radiation to Inhibit Proliferation Post Stenting (SCRIPPS) trial, a prospective randomized trial assessing the effect of iridium-192 (Ir-192) on the prevention of stent restenosis. Fifty-five patients were randomly assigned to receive Ir-192 or placebo sources after successful intervention. Procedural and 6-month follow-up cineangiograms were quantitatively reviewed in 52 patients to identify changes within the stent and the stent + margin segment. The percent diameter stenosis was lower within the stent than within the stent + margin segment after the procedure (6 +/- 22% vs 21+/- 15%, p <0.0001) and at follow-up (28 +/- 29% vs 42 +/- 21%, p <0.0001). As a result, a lower restenosis rate was found within the stent than within the stent + margin (25% vs 37%, p <0.0001); isolated stent margin restenosis occurred in 11.5% of lesions. Treatment with Ir-192 reduced restenosis within the stent (8% vs 39%; p = 0.010) and within the stent + margin segment (17% vs 54%; p = 0.010); the reduction in restenosis at the margin only (8.3% vs 14.3%, p = 0.503) was not significant. The lowest relative risk for restenosis resulting from Ir-192 occurred within the stent (0.21; 95% confidence interval [CI] 0.05 to 0.86) compared with the stent + margin segment (0.31; 95% CI 0.12 to 0.81) or the stent margin (0.58; 95% CI 0.12 to 2.91). In the SCRIPPS trial, 32% of restenosis occurred at the stent margins. Treatment with Ir-192 reduced restenosis primarily within the stent rather than the margin. Whether extending the treatment length to fully include the stent margins will further reduce restenosis requires further study.
authors.affiliation: Department of Internal Medicine, Washington Hospital Center, Washington, DC, USA. AJL1@mhg.edu
authors.forename: A J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: J J
authors.initials: JJ
authors.lastname: Popma
authors.forename: V
authors.initials: V
authors.lastname: Massullo
authors.forename: S
authors.initials: S
authors.lastname: Jani
authors.forename: R J
authors.initials: RJ
authors.lastname: Russo
authors.forename: R A
authors.initials: RA
authors.lastname: Schatz
authors.forename: S
authors.initials: S
authors.lastname: Steuterman
authors.forename: E M
authors.initials: EM
authors.lastname: Guarneri
authors.forename: H
authors.initials: H
authors.lastname: Wu
authors.forename: R
authors.initials: R
authors.lastname: Mehran
authors.forename: G S
authors.initials: GS
authors.lastname: Mintz
authors.forename: M B
authors.initials: MB
authors.lastname: Leon
authors.forename: P S
authors.initials: PS
authors.lastname: Teirstein
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D002455:Cell Division / Q000528:radiation effects; D002932:Cineangiography; D017023:Coronary Angiography / Q000379:methods; D003327:Coronary Disease / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000528:radiation effects; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000532:radiotherapy*; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D011446:Prospective Studies; D011475:Prosthesis Failure; D015607:Stents; D016896:Treatment Outcome; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology* / Q000528:radiation effects; D018084:Ultrasonography, Interventional
chemical_list: D007496:Iridium Radioisotopes