Quantitative angiographic methods for appropriate end-point analysis, edge-effect evaluation, and prediction of recurrent restenosis after coronary brachytherapy with gamma irradiation
Alexandra J. Lansky, MD*,*,
George Dangas, MD, FACC*,
Roxana Mehran, MD, FACC*,
Kartik J. Desai, MD*,
Gary S. Mintz, MD, FACC ,
Hongsheng Wu, PhD,
Martin Fahy, MSc,
Gregg W. Stone, MD, FACC*,
Ron Waksman, MD, FACC and
Martin B. Leon, MD, FACC*
* Cardiovascular Research Foundation and Lenox Hill Heart and Vascular Institute, New York, New York, USA
Departments of Internal Medicine (Cardiology Divisions) of the Washington Hospital Center, Washington, D.C., USA
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Figure 1 Schematic representation of the stent, ribbon, and ribbon+margin segment analysis. A (arrows) represented the axial length of the stent analysis after the procedure; B (arrows) represented the ribbon analysis; C (arrows) represented the ribbon+margin analysis including approximately 5 mm of margins beyond the ribbon (includes any injury). The three analyses at follow-up enabled definition of (a) restenosis at the margin of the stent within the radiated segment [(ribbon restenosis) – (stent restenosis)], (b) restenosis at the margin of the radiation ribbon [(ribbon + margin restenosis) – (ribbon restenosis)], and (c) restenosis beyond the stent margin [(ribbon + margin restenosis) – (stent restenosis)]. Five-millimeter segments of proximal and distal reference diameters are averaged to estimate the reference vessel diameter.
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Figure 2 Frequency of minimal lumen diameters (MLDs) at follow-up demonstrating a bimodal distribution of the iridium and placebo groups using the stent MLD compared to a near-normal distribution of the iridium and placebo groups using the ribbon+margin MLD.
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Figure 3 Probability of recurrent restenosis according to the initial lesion length. Restenoses within the stent (A), the stent edges (B) and the entire treated segment (ribbon+margins, C) are analyzed separately.
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Figure 4 Receiver operator curves of the follow-up percent diameter stenosis (DS) for the stent, ribbon, and ribbon+margin analyses to determine the best surrogate of target vessel revascularization. A follow-up 50% DS obtained from the ribbon or the ribbon+margin analyses had the highest combined sensitivity and specificity for target lesion revascularization. FU = follow-up; ROC = receiver operator curve.
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