title: Angiographic and intravascular ultrasound findings of the late catch-up phenomenon after intracoronary beta-radiation for the treatment of in-stent restenosis.
abstract: 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.
authors.affiliation: Invasive Cardiology Department, Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese 500, São Paulo SP 04012-180, Brazil. fferes@lee.dante.br
authors.forename: Fausto
authors.initials: F
authors.lastname: Feres
authors.forename: Juan
authors.initials: J
authors.lastname: Munoz
authors.forename: Alexandre
authors.initials: A
authors.lastname: Abizaid
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Staico
authors.forename: Mirtes
authors.initials: M
authors.lastname: Kuwabara
authors.forename: Luiz
authors.initials: L
authors.lastname: Mattos
authors.forename: Marinella
authors.initials: M
authors.lastname: Centemero
authors.forename: Galo
authors.initials: G
authors.lastname: Maldonado
authors.forename: Mariano
authors.initials: M
authors.lastname: Albertal
authors.forename: Vinicius D
authors.initials: VD
authors.lastname: Vaz
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ferreira
authors.forename: Luiz F
authors.initials: LF
authors.lastname: Tanajura
authors.forename: Aurea
authors.initials: A
authors.lastname: Chaves
authors.forename: Amanda
authors.initials: A
authors.lastname: Sousa
authors.forename: J Eduardo
authors.initials: JE
authors.lastname: Sousa
mesh_terms: 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