Jm. Ahmed et al., Serial intravascular ultrasound analysis of edge recurrence after intracoronary gamma radiation treatment of native artery in-stent restenosis lesions, AM J CARD, 87(10), 2001, pp. 1145-1149
Citations number
11
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
In the Washington Radiation for in-Stent restenosis Trial (WRIST), patients
were first treated with conventional techniques and then randomized to eit
her gamma -irradiation (Ir-192) or placebo (dummy seeds). In the Ir-192 gro
up with native coronary in-stent restenosis, we identified 8 patients with
edge recurrence and compared them with 21 patients with no recurrence. Seri
al (postirradiation and follow-up) intravascular ultrasound analysis was pe
rformed according to conventional methods. When compared with nonrecurring
lesions, lesions with distal edge recurrence had (1) greater decrease in me
an distal lumen cross-sectional area (-3.0 +/- 1.2 vs -0.7 +/- 1.0 mm(2), p
= 0.0002), (2) no change in mean distal external elastic membrane cross-se
ctional area versus an increase in mean distal cross-sectional area of 1.0
+/- 0.9 mm(2) in nonrecurring lesions (p = 0.0047), and (3) a greater incre
ase in mean distal plaque + media cross-sectional area (2.9 +/- 1.2 mm vs 1
.7 +/- 0.6 mm(2), p = 0.0103). Within the stented segment, the nonrecurring
lesions had no decrease in mean lumen and no increase in mean intimal hype
rplasia cross-sectional area. Conversely, lesions with distal edge recurren
ce had a significant decrease in mean intrastent lumen cross-sectional area
(-1.7 +/- 1.7 mm(2)) and a significant increase in mean intrastent intimal
hyperplasia cross-sectional area (1.6 +/- 1.6 mm(2)). Lesions with distal
edge recurrence also had a greater decrease in mean proximal lumen cross-se
ctional area (-1.7 +/- 1.3 vs -0.3 +/- 0.8 mm(2), p = 0.0213), with a trend
toward a greater increase in mean proximal plaque + media cross-sectional
area. Thus, edge recurrence after Ir-192 treatment of in-stent restenosis i
s the result of neointimal hyperplasia (part of generalized treatment failu
re) and the absence of radiation-induced positive remodeling. (C)2001 by Ex
cerpta Medica, Inc.