Serial intravascular ultrasound analysis of edge recurrence after intracoronary gamma radiation treatment of native artery in-stent restenosis lesions.
In the Washington Radiation for In-Stent restenosis Trial (WRIST), patients were first treated with conventional techniques and then randomized to either gamma-irradiation ((192)Ir) or placebo (dummy seeds). In the (192)Ir group with native coronary in-stent restenosis, we identified 8 patients with edge recurrence and compared them with 21 patients with no recurrence. Serial (postirradiation and follow-up) intravascular ultrasound analysis was performed according to conventional methods. When compared with nonrecurring lesions, lesions with distal edge recurrence had (1) greater decrease in mean distal lumen cross-sectional area (-3.0 +/- 1.2 vs -0.7 +/- 1.0 mm(2), p = 0.0002), (2) no change in mean distal external elastic membrane cross-sectional area versus an increase in mean distal cross-sectional area of 1.0 +/- 0.9 mm(2) in nonrecurring lesions (p = 0.0047), and (3) a greater increase in mean distal plaque + media cross-sectional area (2.9 +/- 1.2 mm vs 1.7 +/- 0.6 mm(2), p = 0.0103). Within the stented segment, the nonrecurring lesions had no decrease in mean lumen and no increase in mean intimal hyperplasia cross-sectional area. Conversely, lesions with distal edge recurrence had a significant decrease in mean intrastent lumen cross-sectional area (-1.7 +/- 1.7 mm(2)) and a significant increase in mean intrastent intimal hyperplasia cross-sectional area (1.6 +/- 1.6 mm(2)). Lesions with distal edge recurrence also had a greater decrease in mean proximal lumen cross-sectional area (-1.7 +/- 1.3 vs -0.3 +/- 0.8 mm(2), p = 0.0213), with a trend toward a greater increase in mean proximal plaque + media cross-sectional area. Thus, edge recurrence after (192)Ir treatment of in-stent restenosis is the result of neointimal hyperplasia (part of generalized treatment failure) and the absence of radiation-induced positive remodeling.
Ahmed
J M
JM
Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories Washington Hospital Center, Washington, DC, USA.
Mintz
G S
GS
Waksman
R
R
Lansky
A J
AJ
Mehran
R
R
Wu
H
H
Weissman
N J
NJ
Pichard
A D
AD
Satler
L F
LF
Kent
K M
KM
Leon
M B
MB
D001918:Brachytherapy; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000528:radiation effects; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D012008:Recurrence; D015607:Stents; D018084:Ultrasonography, Interventional
D007496:Iridium Radioisotopes