title: Serial intravascular ultrasound analysis after intracoronary beta-radiation in long in-stent restenotic lesions.
abstract: In-stent restenosis (ISR) represents the major limitation of stent implantation. Treatment, although of relative technical ease, is unsatisfactory due to the high incidence of recurrent restenosis. Long ISR lesions are especially prone to restenosis. Vascular brachytherapy (VBT) has emerged as a powerful adjunct therapeutic modality to treat ISR. However, VBT may be less effective in very long, diffuse ISR lesions. The present study investigated serial changes of the extent and distribution of neointima formation after beta-radiation as assessed by intravascular ultrasound (IVUS). Following interventional procedures of long ISR in 30 patients, a 40 mm or 60 mm non-centered 90Sr/90Y seed train was used for VBT. Serial (post radiation (PR) and follow-up (FU)) quantitative coronary angiography (QCA) measurements of minimal lumen diameter (MLD) and late lumen loss (LLL) and intravascular ultrasound measurements (IVUS) of cross-sectional areas of the lumen (L-CSA), stent (S-CSA) and intimal hyperplasia (IH-CSA) were performed and compared with historic controls. LLL (0.34 +/- 0.27 mm; p = 0.196), mean decrease of L-CSA (-1.0 +/- 0.8 mm2; p = 0.024) and mean increase of IH-CSA (0.5 +/- 1.3 mm2; p = 0.038) in long ISR were comparable with previously reported results of short ISR. In conclusion the average changes of lumen and intimal hyperplasia after beta-radiation of long ISR are similar to those of short ISR.
authors.affiliation: Medizinische Klinik Klinikum der Ludwig-Maximilians-Universität München-Innenstadt Ziemssenstrasse 1 80336 München, Germany.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Schiele
authors.forename: Andrea
authors.initials: A
authors.lastname: Zimmermann
authors.forename: Johannes
authors.initials: J
authors.lastname: Rieber
authors.forename: Andreas
authors.initials: A
authors.lastname: König
authors.forename: Florian
authors.initials: F
authors.lastname: Krötz
authors.forename: Hae-Y
authors.initials: HY
authors.lastname: Sohn
authors.forename: Ralf
authors.initials: R
authors.lastname: Kantlehner
authors.forename: Barbara
authors.initials: B
authors.lastname: Pöllinger
authors.forename: Eckhart
authors.initials: E
authors.lastname: Dühmke
authors.forename: Karl
authors.initials: K
authors.lastname: Theisen
authors.forename: Gerhard
authors.initials: G
authors.lastname: Bauriedel
authors.forename: Volker
authors.initials: V
authors.lastname: Klauss
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001610:Beta Particles; D001918:Brachytherapy; D002986:Clinical Trials as Topic; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000473:pathology / Q000517:prevention & control / Q000532:radiotherapy*; D003627:Data Interpretation, Statistical; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005720:Gamma Rays; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D010919:Placebos; D011879:Radiotherapy Dosage; D012008:Recurrence; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D017539:Tunica Intima / Q000473:pathology; D018084:Ultrasonography, Interventional
chemical_list: D010919:Placebos