Angiographic and intravascular ultrasound findings of the late catch-up phenomenon after intracoronary beta-radiation for the treatment of in-stent restenosis.
We report one-year angiographic and intravascular ultrasound (IVUS) outcomes of in-stent restenosis (ISR) patients treated with intravascular brachytherapy (IVBT). The benefit of IVBT for treating ISR is well documented. However, few data exist on significant angiographic and intravascular ultrasonic in-stent lumen deterioration beyond the habitual 6-month analysis after the index radiation procedure or so-called late catch-up process in the treatment of ISR. Twenty-five consecutive patients with ISR were treated with IVBT using the Beta-Cath System (a 40 mm 90 Sr per 90 gamma source). Quantitative angiographic and IVUS analysis was performed in all of them at 6 and 12 months. IVBT was successful in all patients. Four patients (16%) developed recurrent angiographic binary restenosis at 6-month follow-up, all located within the adjacent reference segments, with 2 being associated with geographical miss. An additional 4 patients (16%) presented with recurrent ISR at 12-month follow-up, all within the stented segment. Significant in-stent lumen loss (0.16 +/- 0.42 mm to 0.34 +/- 0.46 mm; p = 0.008) and in-stent intimal hyperplasia growth (+11.2 +/- 0.48 mm3; p = 0.03) was observed between 6 and 12 months. Intracoronary beta-radiation for the treatment of ISR was associated with significant luminal deterioration (late catch-up) within the stents between 6 and 12 months due to an important late progression of in-stent intimal hyperplasia.
Feres
Fausto
F
Invasive Cardiology Department, Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese 500, São Paulo SP 04012-180, Brazil. fferes@lee.dante.br
Munoz
Juan
J
Abizaid
Alexandre
A
Staico
Rodolfo
R
Kuwabara
Mirtes
M
Mattos
Luiz
L
Centemero
Marinella
M
Maldonado
Galo
G
Albertal
Mariano
M
Vaz
Vinicius D
VD
Ferreira
Eduardo
E
Tanajura
Luiz F
LF
Chaves
Aurea
A
Sousa
Amanda
A
Sousa
J Eduardo
JE
D001610:Beta Particles; D001918:Brachytherapy / Q000379:methods*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000175:diagnosis* / Q000532:radiotherapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D018084:Ultrasonography, Interventional