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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Edge stenosis and geographical miss following intracoronary gamma radiation therapy for in-stent restenosis

Han-Soo Kim, MD^*, Ron Waksman, MD, FACC^*, Yves Cottin, MD^*, Marc Kollum, MD^*, Balram Bhargava, MD^*, Roxana Mehran, MD, Rosanna C. Chan, PhD and Gary S. Mintz, MD^*

^* Cardiovascular Research Institute, Washington, D.C., USA
Department of Radiation Oncology, Washington Hospital Center, Washington, D.C., USA
Cardiovascular Research Foundation, New York, New York, USA

Manuscript received July 24, 2000; revised manuscript received October 25, 2000, accepted December 14, 2000.

Reprint requests and correspondence: Dr. Ron Waksman, 110 Irving Street, NW, Suite 4B-1, Washington, D.C. 20010
rxw8{at}mhg.edu

OBJECTIVES

We sought to determine the relationship between geographical miss (GM) and edge restenosis (ERS) following intracoronary radiation therapy.

BACKGROUND

Edge restenosis may be a limitation of intracoronary irradiation to prevent in-stent restenosis (ISR). Inadequate radiation source coverage of the injured segment (GM) has been proposed as a cause of ERS. We studied the relationship between GM and ERS following ¹⁹²Ir treatment of ISR.

METHODS

There were 100 patients with native vessel ISR in WRIST (Washington Radiation for In-Stent Restenosis Trial), in which patients with ISR were first treated with conventional techniques and then randomized to gamma irradiation (¹⁹²Ir) or placebo. Geographical miss was defined as segments proximal or distal to the treated lesion that were subjected to injury during primary intervention but were not covered by the radiation source.

RESULTS

Geographical miss was documented in 56 of 164 edges (34%). Edge restenosis was noted at eight of 80 radiated edges and in four of 84 placebo edges. In the irradiated group, ERS was observed in 21% of edges with GM and in 4% of edges without GM (p = 0.035). In contrast, in the placebo group, ERS was observed in only 7% of edges with GM and in 4% of edges without GM (p = NS). The late edge lumen loss was higher in the irradiated group with GM as compared to placebo with GM (0.74 ± 0.57 vs. 0.41 ± 0.50 mm, p = 0.016).

CONCLUSIONS

Edge restenosis following gamma irradiation treatment of ISR is related to GM: a mismatch between the segment of artery injured during the primary catheter-based intervention and the length of the radiation source.

Abbreviations and Acronyms   DS = diameter stenosis   ERS = edge restenosis   GM = geographical miss   IRT = intracoronary radiation therapy   ISR = in-stent restenosis   MLD = minimum lumen diameter   SCRIPPS = Scripps Coronary Radiation to Present Proliferation Post-Stenting Trial   WRIST = Washington Radiation for In-Stent Restenosis Trial

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