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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

View larger version (112K): [in a new window]   Figure 1 (A) Target segment (TS) is between proximal and distal margin of the target lesion, automatically defined by the quantitative coronary angiography system. Vessel segment (VS) is bordered by visible side branches, which encompass the target segment (TS) and the position of the angioplasty balloon and radiation source. (A') Original lesion in the middle part of the right coronary artery before intervention. (B) Injured segment (INS) is defined as the segment encompassed by the most proximal and most distal marker of the angioplasty balloon. (B') Arrows indicate the markers of the deflated angioplasty balloon filmed in place with a contrast injection. (C) The segment encompassed by the inner part of the two tungsten markers of the radiation delivery system defined as the irradiated segments (IRS). (C') Arrows indicate the inner parts of the radiation source tungsten markers filmed with a contrast injection.

View larger version (91K): [in a new window]   Figure 2 (A) Subsegmental analysis before procedure. Vessel segment (VS) was automatically divided into 5-mm subsegments by the CAAS II system. The original lesion is located at segment No. 5 preprocedure as the arrow indicates. (A') Computer defined analysis preprocedure. (B) Subsegmental analysis at postprocedure. Minimum lumen diameter is located at segment No. 6 (arrow). (B') Computer-defined analysis postprocedure. (C) Subsegmental analysis at follow-up. Minimum lumen diameter is located at segment No. 7 (arrow). (C') Computer-defined analysis at follow-up.