Comparative efficacy of gamma-irradiation for treatment of in-stent restenosis in saphenous vein graft versus native coronary artery in-stent restenosis - An intravascular ultrasound study

Article

关键词: BALLOON ANGIOPLASTY;    CELL-PROLIFERATION;    RADIATION THERAPY;    IMPLANTATION;    NEOINTIMA;    DISEASE;    INJURY;   

DOI  :  10.1161/hc5001.101750

来源: SCIE

【 摘 要 】

Background-We used serial volumetric (post-irradiation and follow-up) intravascular ultrasound (IVUS) to compare the effectiveness of gamma -irradiation (Ir-192) in saphenous vein graft (SVG) versus native coronary artery in-stent restenosis (ISR). Methods and Results-The study population consisted of 47 patients with native coronary artery ISR from WRIST (Washington Radiation for In-Stent Restenosis Trial) and 31 patients with SVG ISR (12 from the WRIST and 19 from SVGWRIST). After irradiation and at 6-month follow-up. stent, lumen, and intimal hyperplasia (IH, stent minus lumen) areas were measured every 1 mm. ISR length was similar in the 2 groups (29 +/- 12 versus 29 +/- 14 mm, P = 0.9). Post-intervention measurements of stent (280 +/- 154 versus 324 +/- 270 mm(3), P=0.4), lumen (184 +/- 91 versus 214 +/- 172 mm(3), P=0.3), and IH (96 +/- 77 versus 109 +/- 119 mm(3), P=0.5) volumes were similar in the 2 groups. The post-intervention minimum lumen cross sectional areas tended to be smaller in native artery ISR lesions (4.7 +/- 1.7 versus 5.4 +/- 1.6 mm(2), P=0.11). During follow-up, there was a slight increase in IH volume (-9 +/- 38 mm(3)) in native artery ISR lesions and a slight decrease in IH volume in SVG ISR lesions (-9 +/- 32 mm(3), P=0.0463). There was also a slight decrease in minimum lumen area in the native artery ISR lesions versus a slight increase in minimum lumen area in the SVG ISR lesions (-0.8 +/- 1.7 versus 0.2 +/- 1.1, P=0.0087). As a result, the follow-up minimum lumen area in native artery lesions was smaller than in SVG ISR lesions (4.1 +/- 2.1 mm(2) versus 5.6 +/- 2.2 mm(2), P=0.0067). Conclusion - gamma -Irradiation with Ir-192 brachytherapy appears to be as effective in SVGs as it is in native artery ISR lesions.

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