title: Extra-stent vascular remodeling in in-stent restenosis after 188Re-MAG3 radiation therapy.
abstract: BACKGROUND
  The effect of beta-radiation on extra-stent vascular remodeling in patients with in-stent restenosis has not been studied. The correlation between the extent of extra-stent plaque proliferation and that of intimal hyperplasia (IH) in in-stent restenosis in patients who received beta-radiation therapy as well as conventional therapy has also not been studied.
  
  
  METHODS
  We evaluated the extra-stent remodeling in diffuse in-stent restenosis between a beta-radiation therapy patient group (188Re-MAG3, n=50) and a control group (n=9) by applying serial intravascular ultrasound (IVUS) analysis. Matching (post-intervention and follow-up) images were acquired at the follow-up lesion site and were available in 44 of 50 patients who received radiation therapy and in seven of nine control patients.
  
  
  RESULTS
  There was a significant increase of the external elastic membrane (EEM) area in both groups: 16.4 +/- 3.3 mm2 post-intervention to 17.1 +/- 3.3 mm2 at follow-up, P=0.001 in the radiation therapy group, and 16.8 +/- 4.0 mm2 post-intervention to 17.4 +/- 4.1 mm2 at follow-up, P=0.008 in the control group. There were no statistically significant differences of the Delta EEM area between the two groups: 0.7 +/- 0.4 mm2 in the radiation therapy group vs. 0.6 +/- 0.4 mm2 in the control group, P=0.389. The Delta IH area correlated with the Delta EEM area in the control group (r=0.826, P=0.022), but not in the radiation therapy group (r=0.016, P=0.919).
  
  
  CONCLUSIONS
  The findings of this IVUS study were that positive remodeling (increased EEM area) occurred equally in both control and irradiated patients with in-stent restenosis. The extent of remodeling was directly in proportion to IH in the control group, but no such relationship existed in the irradiated patient group.
authors.affiliation: Department of Medicine, University of Ulsan College of Medicine, Cardiac Center, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, 138-736, Seoul, South Korea
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Dae-Hyuk
authors.initials: DH
authors.lastname: Moon
authors.forename: Seung-Jun
authors.initials: SJ
authors.lastname: Oh
authors.forename: Cheol-Whan
authors.initials: CW
authors.lastname: Lee
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Jun-Hong
authors.initials: JH
authors.lastname: Kim
authors.forename: Yuanchun
authors.initials: Y
authors.lastname: Zhang
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Song
authors.forename: Duk-Hyun
authors.initials: DH
authors.lastname: Kang
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Song
authors.forename: Jae-Joong
authors.initials: JJ
authors.lastname: Kim
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D016022:Case-Control Studies; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000532:radiotherapy*; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia; D009842:Oligopeptides / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000627:therapeutic use; D011868:Radioisotopes / Q000627:therapeutic use*; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D015203:Reproducibility of Results; D012211:Rhenium / Q000627:therapeutic use*; D015607:Stents; D013997:Time Factors; D017539:Tunica Intima / Q000473:pathology; D018084:Ultrasonography, Interventional
chemical_list: D009842:Oligopeptides; D009942:Organometallic Compounds; D011868:Radioisotopes; D019275:Radiopharmaceuticals; C114893:rhenium-mercaptoacetyltriglycine; D012211:Rhenium