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Vascular morphometric changes after radioactivestent implantation: a dose-response analysis

Paul Wexberg, MD, BM^*,*, Christian Kirisits, MScDSc, Mariann Gyöngyösi, MD, PhD^*, Michael Gottsauner-Wolf, MD^*, Meinhard Ploner, MSc, Boris Pokrajac, MD, Richard Pötter, MD and Dietmar Glogar, MD^*

^* Division of Cardiology, Department of Internal Medicine II, University of Vienna, Vienna, Austria
Department of Radiotherapy and Radiobiology and University of Vienna, Vienna, Austria
Division of Biometrics, Department of Medical Computer Sciences, University of Vienna, Vienna, Austria

View larger version (23K): [in a new window]   Figure 1 Schematic drawing of a stented vessel segment. For localization of the cross-sections, see the text. Atherosclerotic plaque was defined as the difference between the lumen area (LA) and the external elastic lamina (EEL) area. Intrastent intimal hyperplasia was defined as the difference between the stent area and the LA at follow-up.

View larger version (18K): [in a new window]   Figure 2 Cumulative dose-volume histogram of three segments from one patient receiving a radioactive stent. The ordinate represents the percentage of target volume receiving at least the respective dose shown at the abscissa. The value of DV10 is marked by a circle and that of DV90 by a diamond. Note the different decline of the curves in each segment resulting in a broad variety of delivered doses, especially of the dose of radiation delivered to at least 10% of the adventitial volume, and a high cumulative dose in the central segments.

View larger version (37K): [in a new window]   Figure 3 Comparison between the delivered dose at 10% and 90% of the adventitia (DV10, DV90), the reduction of the intimal hyperplasia and the increase in external elastic lamina (EEL) area. Note the increased intrastent intimal hyperplasia (IIH) at the stent edges. These segments absorbed lower doses than the stent body but higher doses than the peri-stent segments, which exhibit less intimal hyperplasia. Expansive remodeling occurs within the stent body but not at the edges and the peri-stent segments.

View larger version (14K): [in a new window]   Figure 4 Logarithmic correlation between intrastent intimal hyperplasia (IIH), the dose of radiation delivered to at least 10% of the adventitial volume (DV10) and the dose of radiation delivered to at least 90% of the adventitial volume (DV90).

View larger version (15K): [in a new window]   Figure 5 Logarithmic correlation between expansive remodeling ( external elastic lamina [EEL]), the dose of radiation delivered to at least 10% of the adventitial volume (DV10) and the dose of radiation delivered to at least 90% of the adventitial volume (DV90).