Edge stenosis and geographical miss following intracoronary gamma radiation therapy for in-stent restenosis

Kim, Han‐Soo; Waksman, Ron; Cottin, Yves; Kollum, Marc; Bhargava, Balram; Mehran, Roxana; Chan, Rosanna; Mintz, Gary S.

doi:10.1016/s0735-1097(01)01112-3

Cited by 76 publications

(17 citation statements)

References 18 publications

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“…The previous studies demonstrated that the geographic miss was strongly associated with the development of 6-month restenosis at the edge of irradiation segment [20,21]. However, the effect of geographic miss on late catch-up has not been evaluated.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes after treatment of diffuse in-stent restenosis with rotational atherectomy followed by beta-radiation therapy with a 188Re-MAG3-filled balloon

Lee

Park

Hong

et al. 2005

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Long-term outcomes after treatment of diffuse in-stent restenosis with rotational atherectomy followed by beta-radiation therapy with a 188Re-MAG3-filled balloon

Lee

Park

Hong

et al. 2005

International Journal of Cardiology

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“…Restenting, also, may contribute to late thrombosis [74]. Some studies have addressed that the most cause of restenosis after irradiation therapy is edge restenosis and geographical miss [75][76][77]. These unwilling results have proposed some other treatment modalities such as radioactive stents.…”

Section: Brachitherapymentioning

confidence: 99%

Catheter-based treatment of in-stent restenosis: A review

Erdöl¹,

Çelık²,

Baykan³

2011

Int J Angiol

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Stenting is a safe and efficient method for treatment of ischaemic heart disease. Nevertheless, it gives rise to some additional problems, especially instent restenosis. Several techniques including balloon angioplasty, restenting, rotaablation, excimer laser angioplasty, directional coronary atherectomy, cutting balloon angioplasty, brachitherapy and radioactive stents have been performed to treat in-stent restenosis.

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“…In fact, direct stenting and the use of glycoprotein IIb/IIIa failed to affect restenosis rates with metallic stents and drug-eluting stents. In contrast, the key factors considered essential in improving the results of VBT are adequate dosimetry and radiation coverage with wide margins to avoid geographical miss (16,17) and prolonged antiplatelet therapy to prevent late thrombosis. Nevertheless, the execution of these features was far from optimal; in the BRIDGE study, 21% of vessels had documented geographical miss, suggesting misplacement of the source in relation to the stent position.…”

Section: See Pages 520 and 528mentioning

confidence: 99%

Vascular Brachytherapy and Coronary Stenting for De Novo Lesions

Waksman

2004

Journal of the American College of Cardiology

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Although vascular brachytherapy (VBT) has proved to be effective and safe for the treatment of in-stent restenosis (1-8), its role in the treatment of de novo lesions remains unclear. The clinical trials that were designed to study the effectiveness of various beta radiations for the treatment of de novo coronary lesions reported mixed results. Although feasibility studies such as the Beta Energy Restenosis Trial (BERT) (9), which used 90Sr/Y, the Proliferation Reduction and Vascular Energy trial (10), which used P-32, and the Dose-Finding Study (11), which used a Y-90 emitter, suggested the efficacy and safety of beta radiation for the prevention of restenosis of de novo lesions, the pivotal BetaCath study failed to demonstrate efficacy and raised questions about the safety of using VBT, especially as adjunct therapy to the coronary stenting of de novo lesions (12). See pages 520 and 528The main pitfalls of the BetaCath study were its high incidence of late thrombosis, which was controlled with the administration of prolonged antiplatelet therapy, and the edge effect stenosis phenomenon, which was attributed to geographical miss and insufficient coverage of the injured margins with a sufficient radiation dose (12). As a result, beta-radiation therapy was abound for the prevention of restenosis for de novo lesions and was restricted for the prevention of the recurrence of in-stent restenosis.During the last two years there have been several attempts to revisit and study the possibility of using VBT for the treatment of de novo lesions. These studies were inconclusive and had mixed results. The two studies presented in this issue of the Journal, by Serruys et al. (13) and Sabaté et al. (14), were designed to study the impact of VBT on stented coronary arteries and attempted to implement lessons from previous VBT studies with an emphasis on prolonged antiplatelet therapy-a minimum of six months-and the avoidance of geographical miss. Whereas the BetaRadiation Investigation with Direct stenting and Galileo in Europe (BRIDGE) study was a multicentered study conducted on patients with single lesions Յ18 mm, the study by Sabaté et al. (14) was a single-center study that focused on diabetic patients.The strength of these studies was that they were prospective, randomized, controlled trials that both chose a primary end point reflecting the impact of beta irradiation on neointimal proliferation at six months, either by angiographic intrastent late loss by quantitative coronary angiography in the BRIDGE study or by or intravascular ultrasound alone in the study by Sabaté et al. (14). Both studies had small patient cohorts and were underpowered to detect secondary end points such as clinical events. Nevertheless, both studies met their primary end points, although these were not translated to clinical utility. In both the BRIDGE study and the study by Sabaté et al. (14), a significant reduction in the neointimal volume was noted in the radiation group, which resulted in significantly lower late loss when compared with th...

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Edge stenosis and geographical miss following intracoronary gamma radiation therapy for in-stent restenosis

Abstract: Edge restenosis following gamma irradiation treatment of ISR is related to GM: a mismatch between the segment of artery injured during the primary catheter-based intervention and the length of the radiation source.

Cited by 76 publications

References 18 publications

Long-term outcomes after treatment of diffuse in-stent restenosis with rotational atherectomy followed by beta-radiation therapy with a 188Re-MAG3-filled balloon

Long-term outcomes after treatment of diffuse in-stent restenosis with rotational atherectomy followed by beta-radiation therapy with a 188Re-MAG3-filled balloon

Catheter-based treatment of in-stent restenosis: A review

Vascular Brachytherapy and Coronary Stenting for De Novo Lesions

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