CLINICAL STUDY
Methodological and clinical implications of the relocation of the minimal luminal diameter after intracoronary radiation therapy
Manel Sabaté, MD*,
Marco A. Costa, MD*,
Ken Kozuma, MD*,
I. Patrick Kay, MBChB*,
Connie J. van der Wiel, MSc ,
Vitali Verin, MD, PhD ,
William Wijns, MD, PhD ,
Patrick W. Serruys, MD, PhD, FESC, FACC* on behalf of the Dose Finding Study Group
* Thoraxcenter, Academisch Ziekenhuis Dijkzigt, Rotterdam, The Netherlands
Cardialysis B.V., Rotterdam, The Netherlands
University Hospital, Geneva, Switzerland
O.L.V. Hospital Cardiovascular Center, Aalst, Belgium
Manuscript received January 21, 2000;
revised manuscript received April 24, 2000,
accepted June 21, 2000.
Reprint requests and correspondence: Dr. P.W. Serruys, Heart Center, Academisch Ziekenhuis Rotterdam, Erasmus University, Building 408, Box 2040, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
serruys{at}card.azr.nl
OBJECTIVES
The aims of the study were to determine the incidence of relocation of the minimal luminal diameter (MLD) after beta-radiation therapy following balloon angioplasty (BA) and to describe a new methodological approach to define the effect of brachytherapy on treated coronary stenoses.
BACKGROUND
Luminal diameter of coronary lesions may increase over time following angioplasty and irradiatation. As a result, the MLD at follow-up may be relocated from its location preintervention, which may induce misleading results when a restricted definition of the target segment by quantitative coronary angiography (QCA) is performed.
METHODS
Patients treated with BA followed by intracoronary brachytherapy according to the Dose-Finding Study constituted the study population. A historical cohort of patients treated with BA was used as control group. To be included in the analysis, an accurate angiographic documentation of all instrumentations during the procedure was mandatory. In the irradiated patients, four regions were defined by QCA: vessel segment (VS), target segment (TS), injured segment (INS), and irradiated segment (IRS).
RESULTS
Sixty-five patients from the Dose-Finding Study and 179 control patients were included. At follow-up, MLD was relocated more often in the radiation group (78.5% vs. 26.3%; p < 0.0001). The rate of >50% diameter stenosis differed among the four predefined regions: 3.1% in the TS; 7.7% in the INS; 9.2% in the IRS and 13.8% in the VS.
CONCLUSIONS
Relocation of the MLD is commonly demonstrated after BA and brachytherapy, and it should be taken into account during the analysis of the results of radiation clinical trials.
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Abbreviations and Acronyms
| | BA | = balloon angioplasty | | Gy | = gray | | INS | = injured segment | | IRS | = irradiated segment | | IVUS | = intravascular ultrasound | | MLD | = minimal luminal diameter | | QCA | = quantitative coronary angiography | | TS | = target segment | | VS | = vessel segment |
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