A morphological-mechanical explanation of edge restenosis in lesions treated with vascular brachytherapy.
OBJECTIVE
Edge restenosis in stenotic lesions treated by implantation of a conventional stent followed (or preceded) by a catheter-based brachytherapy is often attributed to "geographic miss" (GM). We propose a complementary (or, possibly, alternative) explanation based on the concept that a clear postprocedural mismatch between the in-stent lumen and the normal (undilated) lumens of the proximal and/or distal vessel segments results in an excessive, damageable increase of axial wall stress in these segments.


METHODS
The possible poststenting situations at both margins of a stent are examined, and based on the presence or absence of an increase in axial wall stress, predictions are made about the lesion evolution. The concept is then also examined in the light of published observations.


RESULTS
None of the analyzed observations appeared to be incompatible with the proposed morphological-mechanical explanation.


CONCLUSIONS
From a mechanical point of view, optimal matching of the proximal and distal stent diameters to the corresponding normal diameters of the adjacent arterial segment is likely to reduce the rate of edge restenosis.
Cardiology Division, University Hospital of Geneva, CH-1211 14, Geneva, Switzerland. pierre-andre.doriot@hcuge.ch
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Doriot
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Dorsaz
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Verin
D001918:Brachytherapy; D004730:Endothelium, Vascular / Q000473:pathology* / Q000503:physiopathology* / Q000528:radiation effects; D006083:Graft Occlusion, Vascular / Q000473:pathology* / Q000503:physiopathology* / Q000532:radiotherapy; D006801:Humans; D033081:Shear Strength; D015607:Stents