CLINICAL STUDY
Geographical miss during catheter-based intracoronary beta-radiation: incidence and implications in the BRIE study
Georgios Sianos, MD*,
I. Patrick Kay, MBChB*,
Marco A. Costa, MD, PhD*,
Evelyn Regar, MD*,
Ken Kozuma, MD*,
Pim J. de Feyter, MD, PhD*,
Eric Boersma, PhD*,
Clemens Disco, MSc and
Patrick W. Serruys, MD, PhD, FESC, FACC*
* Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
Cardialysis BV, Rotterdam, Netherlands
Manuscript received August 11, 2000;
revised manuscript received March 29, 2001,
accepted April 10, 2001.
Reprint requests and correspondence: Prof. P. W. Serruys, Department of Interventional Cardiology, Erasmus Medical Center Rotterdam, Thoraxcenter Bd 404, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands
serruys{at}card.azr.nl
OBJECTIVES
We sought to determine the incidence and causes of geographical miss (GM) and to evaluate its impact on edge restenosis after intracoronary beta-radiation therapy.
BACKGROUND
Edge restenosis is a limitation of intracoronary beta-radiation therapy. Geographical miss is the situation in which the radiation source does not fully cover the injured segment and may lead to edge restenosis.
METHODS
We analyzed 175 vessels treated according to the Beta-Radiation In Europe (BRIE) study protocol. The effective irradiated segment (EIRS) and both edges were studied with quantitative coronary angiography. The edges of the EIRS that were injured constituted the GM edges. Restenosis was defined as diameter stenosis >50% at follow-up. Geographical miss was determined by simultaneous electrocardiographic-matched, side-by-side projection of the source and balloons deflated at the injury site, in identical angiographic projections surrounded by contrast.
RESULTS
Geographical miss affected 41.2% of the edges and increased edge restenosis significantly compared with non-GM edges (16.3% vs. 4.3%, respectively, p = 0.004). Restenosis was increased both in the proximal (p = 0.05) and distal (p = 0.02) GM edges compared with noninjured edges. Geographical miss associated with stent injury significantly increased edge restenosis (p = 0.006), whereas GM related to balloon injury did not significantly increase edge restenosis (p = 0.35). The restenosis in the EIRS was similar between vessels with and without GM (24.3% and 21.6%, respectively, p = 0.8).
CONCLUSIONS
Geographical miss is strongly associated with restenosis at the edges of the EIRS. This effect is more prominent when caused by stenting. Geographical miss does not increase restenosis in the EIRS.
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Abbreviations and Acronyms
| | BE | = balloon edges | | BRIE | = Beta-Radiation In Europe study | | CI | = confidence interval | | EIRS | = effective irradiated segment | | GM | = geographical miss | | Gy | = Gray | | INS | = injured segment | | IVUS | = intravascular ultrasound | | OR | = odds ratio | | QCA | = quantitative coronary angiography | | SE | = stent edges | | VS | = vessel segment |
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