Gamma radiation for in-stent restenosis: effect of lesion length on angiographic and clinical outcomes
Roxana Mehran MD
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York
Search for more papers by this authorIoannis Iakovou MD
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York
Search for more papers by this authorCorresponding Author
George Dangas MD, PhD,
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York
Lenox Hill Heart and Vascular Institute and Cardiovascular Research Foundation, 55 East 59th Street, 6th Floor, New York, NY 10022Search for more papers by this authorAlexandra J. Lansky MD
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York
Search for more papers by this authorGregg W. Stone MD
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York
Search for more papers by this authorGary S. Mintz MD
Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratory, Washington Hospital Center, Washington, D.C
Search for more papers by this authorKenneth M. Kent MD, PhD
Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratory, Washington Hospital Center, Washington, D.C
Search for more papers by this authorAugusto D. Pichard MD
Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratory, Washington Hospital Center, Washington, D.C
Search for more papers by this authorLowell F. Satler MD
Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratory, Washington Hospital Center, Washington, D.C
Search for more papers by this authorMartin Fahy MSc
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York
Search for more papers by this authorMartin B. Leon MD
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York
Search for more papers by this authorRon Waksman MD
Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratory, Washington Hospital Center, Washington, D.C
Search for more papers by this authorRoxana Mehran MD
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York
Search for more papers by this authorIoannis Iakovou MD
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York
Search for more papers by this authorCorresponding Author
George Dangas MD, PhD,
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York
Lenox Hill Heart and Vascular Institute and Cardiovascular Research Foundation, 55 East 59th Street, 6th Floor, New York, NY 10022Search for more papers by this authorAlexandra J. Lansky MD
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York
Search for more papers by this authorGregg W. Stone MD
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York
Search for more papers by this authorGary S. Mintz MD
Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratory, Washington Hospital Center, Washington, D.C
Search for more papers by this authorKenneth M. Kent MD, PhD
Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratory, Washington Hospital Center, Washington, D.C
Search for more papers by this authorAugusto D. Pichard MD
Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratory, Washington Hospital Center, Washington, D.C
Search for more papers by this authorLowell F. Satler MD
Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratory, Washington Hospital Center, Washington, D.C
Search for more papers by this authorMartin Fahy MSc
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York
Search for more papers by this authorMartin B. Leon MD
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York
Search for more papers by this authorRon Waksman MD
Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratory, Washington Hospital Center, Washington, D.C
Search for more papers by this authorAbstract
The relation between lesion length and effectiveness of gamma radiation treatment (γ-RT) has not been well described. We evaluated the acute and long-term outcome according to baseline lesion length in 130 patients treated with 192Ir in the Washington Radiation for In-Stent Restenosis Trial; 44 (35.5%) had baseline short in-stent restenosis (ISR) lesions (length < 15 mm) and 80 (64.5%) long ISR lesions (length ≥ 15 mm). At 6-month follow-up after γ-RT, the short ISR group had larger lumen dimensions and lower late loss than the long ISR group. Restenosis rate was significantly higher in patients with long ISR for both the placebo (74% vs. 39%; P = 0.01) and the γ-RT arm (31% vs. 5.3%; P = 0.04). γ-RT significantly improved the angiographic outcome in the short-lesion groups but had the more pronounced effect on the reduction of clinical events after treatment of long ISR group. Lesion length remains a powerful predictor of recurrent ISR and clinical events after treatment of ISR even with γ-RT. Catheter Cardiovasc Interv 2004;61:354–359. © 2004 Wiley-Liss, Inc.
REFERENCES
- 1 El-Omar MM, Dangas G, Iakovou I, Mehran R. Update on in-stent restenosis. Curr Interv Cardiol Rep 2001; 3: 296–305.
- 2 Hoffmann R, Mintz GS, Dussaillant GR, et al. Patterns and mechanisms of in-stent restenosis: a serial intravascular ultrasound study. Circulation 1996; 94: 1247–1254.
- 3 Mehran R, Dangas G, Abizaid AS, et al. Angiographic patterns of in-stent restenosis: classification and implication for long-term outcome. Circulation 1999; 100: 1872–1878.
- 4 Mehran R, Mintz GS, Satler LF, et al. Treatment of in-stent restenosis with excimer laser coronary angioplasty: mechanisms and results compared to PTCA alone. Circulation 1997; 96: 2183–2189.
- 5 Mehran R, Dangas G, Mintz GS, et al. Treatment of in-stent restenosis with excimer laser coronary angioplasty versus rotational atherectomy: comparative mechanisms and results. Circulation 2000; 101: 2484–2489.
- 6 Remiers B, Moussa I, Akiyama T, et al. Long-term clinical follow-up after successful repeat percutaneous intervention for stent restenosis. J Am Coll Cardiol 1997; 30: 186–192.
- 7 Mintz GS, Weissman NJ, Teirstein PS, et al. Effect of intracoronary γ-radiation therapy on in-stent restenosis: an intravascular ultrasound analysis from the gamma-1 study. Circulation 2000; 102: 2915–2918.
- 8 Ahmed JM, Mintz GS, Waksman R, et al. Serial intravascular ultrasound analysis of the impact of lesion length on the efficacy of intracoronary γ-irradiation for preventing recurrent in-stent restenosis. Circulation 2001; 103: 188–191.
- 9 Hoffmann R, Mintz GS, Dussaillant GR, et al. Patterns and mechanisms of in-stent restenosis: a serial intravascular ultrasound study. Circulation 1996; 94: 1247–1254.
- 10 Ajani AE, Waksman R, Cha DH, et al. The impact of lesion length and reference vessel diameter on angiographic restenosis and target vessel revascularization in treating in-stent restenosis with radiation. J Am Coll Cardiol 2002; 39: 1290–1296.
- 11 Waksman R, White L, Chan R, et al. Intracoronary radiation therapy after angioplasty inhibits recurrence in patients with in-stent restenosis. Circulation 2000; 101: 2165–2171.
- 12 Lansky AJ, Popma JJ. Qualitative and quantitative angiography. In: E Topol, editor. Textbook of interventional cardiology. Philadelphia: W.B. Saunders; 1999. p 725–747.
- 13 Lansky AJ, Dangas G, Mehran R, et al. Quantitative angiographic methods for appropriate end-point analysis, edge-effect evaluation, and prediction of recurrent restenosis after coronary brachytherapy with gamma irradiation. J Am Coll Cardiol 2002; 39: 274–280.
- 14 Amant C, Bauters C, Bodart JC, et al. D allele of angiotensin I-converting enzyme is a major risk factor for restenosis after coronary stenting. Circulation 1997; 96: 56–60.
- 15 Dussaillant GR, Mintz GS, Pichard AD, et al. Small stent size and intimal hyperplasia contribute to restenosis: a volumetric intravascular ultrasound analysis. J Am Coll Cardiol 1995; 26: 720–724.
- 16 Teirstein PS, Massullo V, Jani S, et al. A double-blinded randomized trial of catheter-based radiotherapy to inhibit restenosis following coronary stenting. N Engl J Med 1997; 336: 1697–1703.
- 17 Kornowski R, Mintz GS, Kent KM, et al. Increased restenosis in diabetes mellitus after coronary interventions is due to exaggerated intimal hyperplasia: a serial intravascular ultrasound study. Circulation 1997; 95: 1366–1369.
- 18 Bossi I, Klersy C, Black AJ, et al. In-stent restenosis: long-term outcome and predictors of subsequent target lesion revascularization after repeat balloon angioplasty. J Am Coll Cardiol 2000; 35: 1569–1576.
- 19 Ahmed JM, Mintz GS, Waksman R, et al. Serial intravascular ultrasound assessment of the efficacy of intracoronary (gamma)-radiation therapy for preventing recurrence in very long, diffuse, in-stent restenosis lesions. Circulation 2001; 104: 856–859.
- 20 Sabate M, Marijnissen JP, Carlier SG, et al. Residual plaque burden, delivered dose, and tissue composition predict 6-month outcome after balloon angioplasty and β-radiation therapy. Circulation 2000; 101: 2472–2477.
- 21 Tanabe K, Serruys PW, Grube E, et al. TAXUS III trial: in-stent restenosis treated with stent-based delivery of paclitaxel incorporated in a slow-release polymer formulation. Circulation 2003; 107: 559–564.
- 22 Sousa JE, Costa MA, Abizaid A, et al. Sirolimius-eluting stent for the treatment of in-stent restenosis: a quantitative coronary angiography and three dimensional intravascular ultrasound study. Circulation 2003; 107: 24–47.
- 23 Colombo A, Orlic D, Stankovic G, et al. Preliminary observations regarding angiographic pattern of restenosis after rapamycin-eluting stent implantation. Circulation 2003; 107: 2178–2180.
