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
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Figure 1 Schematic representation of geographical miss (GM) and edge restenosis (ERS). (Top) During the procedure, the proximal segment represented GM (+) (treated lesion subjected to injury but not covered by the radiation catheter) and the distal segment represented GM (–) (treated lesion covered adequately with the radiation catheter). (Bottom) At follow-up this proximal edge with GM developed ERS and the distal edge without GM showed no ERS.
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Figure 2 An example of GM induced by balloon dilation, not covered by radiation catheter, presenting with edge stenosis at six-month follow-up. (A) Diffuse lesion located in the right coronary artery. (B) One of the balloon dilatations (between arrows) performed during the intervention. (C) The radiation delivery catheter in place (between arrows) proximal to the balloon injured segment. (D) Final result. (E) Six-month follow-up: reduction in lumen at the edge with geographical miss (between arrows).
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