Quantitative angiographic analysis of stent restenosis in the Scripps Coronary Radiation to Inhibit Intimal Proliferation Post Stenting (SCRIPPS) Trial.
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.
Lansky
A J
AJ
Department of Internal Medicine, Washington Hospital Center, Washington, DC, USA. AJL1@mhg.edu
Popma
J J
JJ
Massullo
V
V
Jani
S
S
Russo
R J
RJ
Schatz
R A
RA
Steuterman
S
S
Guarneri
E M
EM
Wu
H
H
Mehran
R
R
Mintz
G S
GS
Leon
M B
MB
Teirstein
P S
PS
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
D007496:Iridium Radioisotopes