Sensitivity and specificity of QCA in detecting coronary arterial remodeling after intracoronary brachytherapy: a comparison to serial volumetric three-dimensional intravascular ultrasound analysis. Can we detect positive remodeling by luminography?
BACKGROUND
After treatment with intracoronary brachytherapy, enlargement of lumen (negative late loss) at follow-up has been demonstrated. The aim of the study is to analyze the sensitivity and specificity of quantitative coronary angiography (QCA) parameters to detect a positive vessel remodeling after intracoronary -radiation as compared to intravascular ultrasound (IVUS).


METHODS
Twenty-seven patients (27 vessels) treated with balloon angioplasty followed by catheter-based intracoronary -radiation with a (90)Strontium/(90)Yttrium source were assessed by both QCA and three-dimensional IVUS with electrocardiogram-gated pullback. Irradiated segments were analyzed over the total treatment length and in subsegment lengths of 5 mm.


RESULTS
Change in minimum luminal diameter (MLD) was not a predictor for the positive remodeling in either total irradiated segments or 5 mm subsegments, with a 54.3% ROC curve area [95% confidence interval (CI), 30-79%], sensitivity of 39% and specificity of 44% (p = not significant) in the total irradiated segments and a 55.9% ROC curve area (95% CI, 46-66%), sensitivity of 55% and specificity of 54% (p = not significant) in the 5 mm subsegments. Changes in mean and maximal lumen diameter were not significant parameters to detect positive vessel remodeling. When only central subsegments were analyzed, change in MLD was a significant predictor, with a 63.3% ROC curve area (95% CI, 52-75%), sensitivity of 55% and specificity of 64% (p = 0.029).


CONCLUSIONS
Lumen enlargement detected by QCA does not reliably indicate a positive vessel remodeling after intracoronary radiation. IVUS analysis may be necessary to investigate the mechanism of restenosis after balloon angioplasty followed by catheter-based radiation.
Kozuma
Ken
K
Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Regar
Evelyn
E
Bruining
Nico
N
van der Giessen
Willem
W
Boersma
Eric
E
Foley
David P
DP
de Feyter
Pim J
PJ
Levendag
Peter C
PC
Serruys
Patrick W
PW
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001918:Brachytherapy / Q000009:adverse effects*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional / Q000379:methods*