Late intravascular ultrasound findings of patients treated with brachytherapy for diffuse in-stent restenosis

Myeong Ki Hong, Gary S. Mintz, Cheol Whan Lee, Young Hak Kim, Seung Whan Lee, Dae Hyuk Moon, Seung Jun Oh, Jong Min Song, Ki Hoon Han, Duk Hyun Kang, Jae Kwan Song, Jae Joong Kim, Seong Wook Park, Seung Jung Park

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Abstract

This study aimed at evaluating long-term (24-month) effects of β-irradiation (188Re-MAG3-filled balloon) using intravascular ultrasound (IVUS) in patients with in-stent restenosis (ISR). Long-term effects of β-irradiation on intimal hyperplasia (IH) within the stented segment and vessel and lumen dimensions of nonstented adjacent segments in patients with ISR have not been sufficiently evaluated. Two-year follow-up IVUS was performed in 30 patients with patent ISR segments at 6-month follow-up angiography. Serial IVUS images were acquired at five equidistant intrastent sites and at three different reference segment sites. IH burden (%) was defined as 100 × (IH/stent area). Mean intrastent IH area and IH burden significantly increased between 6 and 24 months, from 2.1 ± 1.1 to 2.6 ±v 1.4 mm2 (P < 0.001) and from 26% ± 10% to 33% ± 14% (P < 0.001), respectively. There was a significant decrease of mean external elastic membrane (from 10.1 ± 3.9 to 9.7 ± 3.9 mm2; P = 0.015) and lumen area (from 5.6 ± 2.3 to 5.1 ± 2.3 mm2; P = 0.021) within distal reference segments between 6 and 24 months. Target lesion revascularization (TLR) was performed in six patients (20%) between 6 and 24 months after β-irradiation therapy. There were no significant differences between TLR and non-TLR groups except for a smaller minimum lumen area at 24 months in the TLR group. Because of a small amount of late loss between 6 and 24 months, most irradiated ISR vessel segments remained stable for up to 2 years. However, quantitative evidence of late catch-up was evident in most patients and was significantly associated with 24-month TLR in some patients.

Original languageEnglish
Pages (from-to)208-214
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume63
Issue number2
DOIs
Publication statusPublished - 2004 Oct 1

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Tunica Intima
Brachytherapy
Stents
Hyperplasia
Angiography
Membranes

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Hong, Myeong Ki ; Mintz, Gary S. ; Lee, Cheol Whan ; Kim, Young Hak ; Lee, Seung Whan ; Moon, Dae Hyuk ; Oh, Seung Jun ; Song, Jong Min ; Han, Ki Hoon ; Kang, Duk Hyun ; Song, Jae Kwan ; Kim, Jae Joong ; Park, Seong Wook ; Park, Seung Jung. / Late intravascular ultrasound findings of patients treated with brachytherapy for diffuse in-stent restenosis. In: Catheterization and Cardiovascular Interventions. 2004 ; Vol. 63, No. 2. pp. 208-214.
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title = "Late intravascular ultrasound findings of patients treated with brachytherapy for diffuse in-stent restenosis",
abstract = "This study aimed at evaluating long-term (24-month) effects of β-irradiation (188Re-MAG3-filled balloon) using intravascular ultrasound (IVUS) in patients with in-stent restenosis (ISR). Long-term effects of β-irradiation on intimal hyperplasia (IH) within the stented segment and vessel and lumen dimensions of nonstented adjacent segments in patients with ISR have not been sufficiently evaluated. Two-year follow-up IVUS was performed in 30 patients with patent ISR segments at 6-month follow-up angiography. Serial IVUS images were acquired at five equidistant intrastent sites and at three different reference segment sites. IH burden ({\%}) was defined as 100 × (IH/stent area). Mean intrastent IH area and IH burden significantly increased between 6 and 24 months, from 2.1 ± 1.1 to 2.6 ±v 1.4 mm2 (P < 0.001) and from 26{\%} ± 10{\%} to 33{\%} ± 14{\%} (P < 0.001), respectively. There was a significant decrease of mean external elastic membrane (from 10.1 ± 3.9 to 9.7 ± 3.9 mm2; P = 0.015) and lumen area (from 5.6 ± 2.3 to 5.1 ± 2.3 mm2; P = 0.021) within distal reference segments between 6 and 24 months. Target lesion revascularization (TLR) was performed in six patients (20{\%}) between 6 and 24 months after β-irradiation therapy. There were no significant differences between TLR and non-TLR groups except for a smaller minimum lumen area at 24 months in the TLR group. Because of a small amount of late loss between 6 and 24 months, most irradiated ISR vessel segments remained stable for up to 2 years. However, quantitative evidence of late catch-up was evident in most patients and was significantly associated with 24-month TLR in some patients.",
author = "Hong, {Myeong Ki} and Mintz, {Gary S.} and Lee, {Cheol Whan} and Kim, {Young Hak} and Lee, {Seung Whan} and Moon, {Dae Hyuk} and Oh, {Seung Jun} and Song, {Jong Min} and Han, {Ki Hoon} and Kang, {Duk Hyun} and Song, {Jae Kwan} and Kim, {Jae Joong} and Park, {Seong Wook} and Park, {Seung Jung}",
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Hong, MK, Mintz, GS, Lee, CW, Kim, YH, Lee, SW, Moon, DH, Oh, SJ, Song, JM, Han, KH, Kang, DH, Song, JK, Kim, JJ, Park, SW & Park, SJ 2004, 'Late intravascular ultrasound findings of patients treated with brachytherapy for diffuse in-stent restenosis', Catheterization and Cardiovascular Interventions, vol. 63, no. 2, pp. 208-214. https://doi.org/10.1002/ccd.20118

Late intravascular ultrasound findings of patients treated with brachytherapy for diffuse in-stent restenosis. / Hong, Myeong Ki; Mintz, Gary S.; Lee, Cheol Whan; Kim, Young Hak; Lee, Seung Whan; Moon, Dae Hyuk; Oh, Seung Jun; Song, Jong Min; Han, Ki Hoon; Kang, Duk Hyun; Song, Jae Kwan; Kim, Jae Joong; Park, Seong Wook; Park, Seung Jung.

In: Catheterization and Cardiovascular Interventions, Vol. 63, No. 2, 01.10.2004, p. 208-214.

Research output: Contribution to journalArticle

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T1 - Late intravascular ultrasound findings of patients treated with brachytherapy for diffuse in-stent restenosis

AU - Hong, Myeong Ki

AU - Mintz, Gary S.

AU - Lee, Cheol Whan

AU - Kim, Young Hak

AU - Lee, Seung Whan

AU - Moon, Dae Hyuk

AU - Oh, Seung Jun

AU - Song, Jong Min

AU - Han, Ki Hoon

AU - Kang, Duk Hyun

AU - Song, Jae Kwan

AU - Kim, Jae Joong

AU - Park, Seong Wook

AU - Park, Seung Jung

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N2 - This study aimed at evaluating long-term (24-month) effects of β-irradiation (188Re-MAG3-filled balloon) using intravascular ultrasound (IVUS) in patients with in-stent restenosis (ISR). Long-term effects of β-irradiation on intimal hyperplasia (IH) within the stented segment and vessel and lumen dimensions of nonstented adjacent segments in patients with ISR have not been sufficiently evaluated. Two-year follow-up IVUS was performed in 30 patients with patent ISR segments at 6-month follow-up angiography. Serial IVUS images were acquired at five equidistant intrastent sites and at three different reference segment sites. IH burden (%) was defined as 100 × (IH/stent area). Mean intrastent IH area and IH burden significantly increased between 6 and 24 months, from 2.1 ± 1.1 to 2.6 ±v 1.4 mm2 (P < 0.001) and from 26% ± 10% to 33% ± 14% (P < 0.001), respectively. There was a significant decrease of mean external elastic membrane (from 10.1 ± 3.9 to 9.7 ± 3.9 mm2; P = 0.015) and lumen area (from 5.6 ± 2.3 to 5.1 ± 2.3 mm2; P = 0.021) within distal reference segments between 6 and 24 months. Target lesion revascularization (TLR) was performed in six patients (20%) between 6 and 24 months after β-irradiation therapy. There were no significant differences between TLR and non-TLR groups except for a smaller minimum lumen area at 24 months in the TLR group. Because of a small amount of late loss between 6 and 24 months, most irradiated ISR vessel segments remained stable for up to 2 years. However, quantitative evidence of late catch-up was evident in most patients and was significantly associated with 24-month TLR in some patients.

AB - This study aimed at evaluating long-term (24-month) effects of β-irradiation (188Re-MAG3-filled balloon) using intravascular ultrasound (IVUS) in patients with in-stent restenosis (ISR). Long-term effects of β-irradiation on intimal hyperplasia (IH) within the stented segment and vessel and lumen dimensions of nonstented adjacent segments in patients with ISR have not been sufficiently evaluated. Two-year follow-up IVUS was performed in 30 patients with patent ISR segments at 6-month follow-up angiography. Serial IVUS images were acquired at five equidistant intrastent sites and at three different reference segment sites. IH burden (%) was defined as 100 × (IH/stent area). Mean intrastent IH area and IH burden significantly increased between 6 and 24 months, from 2.1 ± 1.1 to 2.6 ±v 1.4 mm2 (P < 0.001) and from 26% ± 10% to 33% ± 14% (P < 0.001), respectively. There was a significant decrease of mean external elastic membrane (from 10.1 ± 3.9 to 9.7 ± 3.9 mm2; P = 0.015) and lumen area (from 5.6 ± 2.3 to 5.1 ± 2.3 mm2; P = 0.021) within distal reference segments between 6 and 24 months. Target lesion revascularization (TLR) was performed in six patients (20%) between 6 and 24 months after β-irradiation therapy. There were no significant differences between TLR and non-TLR groups except for a smaller minimum lumen area at 24 months in the TLR group. Because of a small amount of late loss between 6 and 24 months, most irradiated ISR vessel segments remained stable for up to 2 years. However, quantitative evidence of late catch-up was evident in most patients and was significantly associated with 24-month TLR in some patients.

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