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(Circulation. 2001;104:3020.)
© 2001 American Heart Association, Inc.

Brief Rapid Communications

Comparative Efficacy of -Irradiation for Treatment of In-Stent Restenosis in Saphenous Vein Graft Versus Native Coronary Artery In-Stent Restenosis

An Intravascular Ultrasound Study

Marco T. Castagna, MD; Gary S. Mintz, MD; Ron Waksman, MD; Javed M. Ahmed, MD; Akiko Maehara, MD; Andrew E. Ajani, MD; Anh B. Bui, MD; Lowell F. Satler, MD; William O. Suddath, MD; Kenneth M. Kent, MD; Augusto D. Pichard, MD; Neil J. Weissman, MD

From the Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories (M.T.C., R.W., J.M.A., A.M., A.E.A., A.B.B., L.F.S., W.O.S., K.M.K, A.D.P., N.J.W.), Cardiovascular Research Institute, Washington Hospital Center, Washington, DC; and Cardiovascular Research Foundation (G.S.M.), New York, NY.

Correspondence to Neil J. Weissman, MD, Cardiovascular Research Institute, 110 Irving St, NW, Suite 4B-1, Washington, DC 20010. E-mail Neil.J.Weissman{at}medstar.net

Background— We used serial volumetric (post-irradiation and follow-up) intravascular ultrasound (IVUS) to compare the effectiveness of -irradiation (¹⁹²Ir) in saphenous vein graft (SVG) versus native coronary artery in-stent restenosis (ISR).

Methods and Results— The study population consisted of 47 patients with native coronary artery ISR from WRIST (Washington Radiation for In-Stent Restenosis Trial) and 31 patients with SVG ISR (12 from the WRIST and 19 from SVGWRIST). After irradiation and at 6-month follow-up, stent, lumen, and intimal hyperplasia (IH, stent minus lumen) areas were measured every 1 mm. ISR length was similar in the 2 groups (29±12 versus 29±14 mm, P=0.9). Post-intervention measurements of stent (280±154 versus 324±270 mm³, P=0.4), lumen (184±91 versus 214±172 mm³, P=0.3), and IH (96±77 versus 109±119 mm³, P=0.5) volumes were similar in the 2 groups. The post-intervention minimum lumen cross sectional areas tended to be smaller in native artery ISR lesions (4.7±1.7 versus 5.4±1.6 mm², P=0.11). During follow-up, there was a slight increase in IH volume (9±38 mm³) in native artery ISR lesions and a slight decrease in IH volume in SVG ISR lesions (-9±32 mm³, P=0.0463). There was also a slight decrease in minimum lumen area in the native artery ISR lesions versus a slight increase in minimum lumen area in the SVG ISR lesions (-0.8±1.7 versus 0.2±1.1, P=0.0087). As a result, the follow-up minimum lumen area in native artery lesions was smaller than in SVG ISR lesions (4.1±2.1 mm² versus 5.6±2.2 mm², P=0.0067).

Conclusion— -Irradiation with ¹⁹²Ir brachytherapy appears to be as effective in SVGs as it is in native artery ISR lesions.

Key Words: restenosis • stents • ultrasonics • imaging • radiation

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