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(Circulation. 2001;103:188.)
© 2001 American Heart Association, Inc.

Brief Rapid Communication

Serial Intravascular Ultrasound Analysis of the Impact of Lesion Length on the Efficacy of Intracoronary -Irradiation for Preventing Recurrent In-Stent Restenosis

Javed M. Ahmed, MRCP; Gary S. Mintz, MD; Ron Waksman, MD; Neil J. Weissman, MD; Borjanka Leiboff, MD; Augusto D. Pichard, MD; Lowell F. Satler, MD; Kenneth M. Kent, MD, PhD; Martin B. Leon, MD

From the Cardiovascular Research Institute, Washington Hospital Center, Washington, DC.

Correspondence to Neil J. Weissman, MD, 110 Irving St NW, Suite 4B1, Washington, DC 20010. E-mail njw1{at}mhg.edu

Background—The relation between lesion length and effectiveness of brachytherapy is not well studied.

Methods and Results—We compared serial (postintervention and follow-up) intravascular ultrasound findings in 66 patients with native coronary artery in-stent restenosis (ISR) who were treated with ¹⁹²Ir (15 Gy delivered 2 mm away from the radiation source). Patients were enrolled in the Washington Radiation for In-Stent Restenosis Trial (WRIST; ISR length, 10 to 47 mm; n=36) or Long WRIST (ISR length, 36 to 80 mm; n=30). External elastic membrane, stent, lumen, and intimal hyperplasia (IH; stent minus lumen) areas and source-to-target (intravascular ultrasound catheter to external elastic membrane) distances were measured. Postintervention stent areas were larger in WRIST and smaller in Long WRIST patients (P<0.0001). At follow-up, maximum IH area significantly increased in both WRIST and Long WRIST patients (P<0.0001 for both), but this increase was greater in Long WRIST patients (P=0.0006). Similarly, minimum lumen cross-sectional area significantly decreased in both WRIST and Long WRIST patients (P<0.05 and P<0.0001, respectively), but this decrease was more pronounced in Long WRIST patients (P=0.0567). The maximum source-to-target distance was longer in Long WRIST than in WRIST, and it correlated directly with ISR length (r=0.547, P<0.0001). Overall, the change in minimum lumen area and the change in maximum IH area correlated with the maximum source-to-target distance (r=0.352, P=0.0038 and r=0.523, P<0.0001 for WRIST and Long WRIST, respectively). The variability (maximum/minimum) in IH area at follow-up also correlated with the maximum source-to-target distance (r=0.378, P<0.0001).

Conclusions—Brachytherapy may be less effective in longer ISR lesions because of the greater variability and longer source-to-target distances in diffuse ISR.

Key Words: stents • restenosis • imaging

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