title: Safety of intracoronary gamma-radiation on uninjured reference segments during the first 6 months after treatment of in-stent restenosis: a serial intravascular ultrasound study.
abstract: BACKGROUND
  The effects of endovascular irradiation on uninjured reference segments during the treatment of in-stent restenosis are unknown.
  
  
  RESULTS
  In the Washington Radiation for In-Stent restenosis Trial (WRIST), patients with in-stent restenosis were first treated with conventional catheter-based techniques and then randomized (blinded) to receive either gamma-irradiation ((192)Ir) or a placebo (dummy seeds). We identified all patients in whom the active (n=19) or dummy seeds (n=19) extended >10 mm proximal and distal to the in-stent restenosis lesion. Serial (postirradiation and follow-up) external elastic membrane (EEM), lumen, and plaque and media (EEM-lumen) areas were measured (using intravascular ultrasound) every 1 mm over 5-mm-long reference segments that were 6 to 10 mm proximal and distal to the in-stent restenosis lesion. During follow-up, a similar small increase occurred in the plaque and media area in the proximal and distal reference segments in both (192)Ir and placebo patients. However, in the (192)Ir patients, an increase in both proximal and distal EEM area occurred; as a result, no change in lumen area occurred. Conversely, in the placebo patients, the proximal reference EEM area decreased, and no change occurred in the distal reference EEM area; this contributed to a decrease in lumen area.
  
  
  CONCLUSIONS
  There was no evidence of a deleterious effect of gamma-irradiation on angiographically normal uninjured reference segments in the first 6 months after the treatment of in-stent restenosis.
authors.affiliation: Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories, Washington Hospital Center, Washington, DC, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Ahmed
authors.forename: G S
authors.initials: GS
authors.lastname: Mintz
authors.forename: R
authors.initials: R
authors.lastname: Waksman
authors.forename: N J
authors.initials: NJ
authors.lastname: Weissman
authors.forename: R
authors.initials: R
authors.lastname: Mehran
authors.forename: A D
authors.initials: AD
authors.lastname: Pichard
authors.forename: L F
authors.initials: LF
authors.lastname: Satler
authors.forename: K M
authors.initials: KM
authors.lastname: Kent
authors.forename: M B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000528:radiation effects*; D004311:Double-Blind Method; D004547:Elastic Tissue / Q000000981:diagnostic imaging / Q000528:radiation effects; D006801:Humans; D012008:Recurrence; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional