Intravascular ultrasound volumetric assessment of intimal hyperplasia in stents treated with intracoronary radiation

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Coronary stenting and restenosis (n=3). Intervention: Iridium-192 (γ)-radiation vs. Without Ir-192 (γ)-radiation. Primary outcome: Plaque area changes as a function of position in the treated segment.

Q: What does this research mean for the field?

Volumetric intravascular ultrasound allows detailed spatial assessment of neointimal hyperplasia changes across stent and reference segments following intracoronary iridium-192 radiation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Thosaphol Limpijankit; Ron Waksman; Paul G. Yock; Peter J. Fitzgerald

doi:10.1016/s0002-9149(99)00449-x

October 1, 1999The American Journal of CardiologyOpen Access

Intravascular ultrasound volumetric assessment of intimal hyperplasia in stents treated with intracoronary radiation

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Key result

Ir-192 radiation effects on plaque area versus control are unreported in this case report abstract.

n=3

Why the study?

Does Ir-192 (γ)- radiation reduce intimal hyperplasia and plaque area changes in patients with stents?

Key Points

To assess volumetric and spatial changes in intimal hyperplasia along stented coronary segments and adjacent reference vessels following intracoronary radiation.
Assessed longitudinal and cross-sectional plaque area variations using intravascular ultrasound (IVUS) volumetric analysis.
Compared vascular responses across 3 patients treated with or without intracoronary iridium-192 (Ir-192) gamma radiation.
Positional analysis revealed specific spatial distributions of neointimal tissue across the length of stented segments in response to intracoronary radiation.

Study Design

Type

Case Report (n=3)

Structured PICO

Does Ir-192 (γ)- radiation reduce intimal hyperplasia and plaque area changes in patients with stents?

P

Population

3 patients treated either with or without Ir-192 (γ)-radiation to assess plaque area changes.

I

Intervention

Ir-192 (γ)- radiation

C

Comparator

No Ir-192 (γ)- radiation

O

Outcome

Plaque area changes as a function of position in the treated segment measured by intravascular ultrasound (IVUS)surrogate

This small report aims to assess the magnitude and distribution of neointimal tissue inside stents after intracoronary radiation therapy using IVUS.

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Answers are grounded in this paper and cite their sources.

Implication

Case report of 3 patients provides no clinical guidance on Ir-192 for in-stent hyperplasia; leaves open efficacy for prospective IVUS trials.

Abstract

Radiation emerged over the last 3 years as a potential antiproliferative therapy to prevent restenosis in the coronary arteries. 1 Waksman R Robinson K.A Crocker I.R Gravanis M.B Palmer S.J Wang C Cipolla G.D King S.B Intracoronary radiation before stent implantation inhibits neointima formation in stented porcine coronary arteries. Circulation. 1995; 92: 1383-1386 Crossref PubMed Scopus (190) Google Scholar , 2 Wiedermann J.G Marboe C Amols H Schwartz A Weinberger J Intracoronary irradiation markedly reduces neointimal proliferation after balloon angioplasty in swine persistent benefit at 6-month follow-up. J Am Coll Cardiol. 1995; 25: 1451-1456 Abstract Full Text PDF PubMed Scopus (202) Google Scholar , 3 Verin V Popowski Y Urban P Belenger J Redard M Costa M Widmer M.C Rouzaud M Nouet P Grob E et al. Intra-arterial beta irradiation prevents neointimal hyperplasia in a hypercholesterolemic rabbit restenosis model. Circulation. 1995; 92: 2284-2290 Crossref PubMed Scopus (164) Google Scholar , 4 Weinberger J Amols H Ennis R.D Schwartz A Wiedermann J.G Marboe C Intracoronary irradiation dose response for the prevention of restenosis in swine. Int J Radiat Oncol Biol Phys. 1996; 36: 767-775 Abstract Full Text PDF PubMed Scopus (139) Google Scholar In vivo animal models and human studies have shown the effectiveness of intracoronary radiation in inhibiting late lumen loss, either by inhibition of neointimal formation 5 Waksman R Robinson K.A Crocker I.R Wang C Gravanis M.B Cipolla G.D Hillstead R.A King S.R Intracoronary low-dose beta-irradiation inhibits neointima formation after coronary artery balloon injury in the swine restenosis model. Circulation. 1995; 92: 3025-3031 Crossref PubMed Scopus (265) Google Scholar , 6 Waksman R Robinson K.A Crocker I.R Gravanis M.B Cipolla G.D King S.R Endovascular low-dose irradiation inhibits neointima formation after coronary artery balloon injury in swine. A possible role for radiation therapy in restenosis prevention. Circulation. 1995; 91: 1533-1539 Crossref PubMed Scopus (361) Google Scholar , 7 Teirstein P.S Massullo V Jani S Popma J.J Mintz G.S Russo R.J Schatz R.A Guarneri E.M Steuterman S Morris N.B Leon M.B Tripuraneni P Catheter-based radiotherapy to inhibit restenosis after coronary stenting. N Engl J Med. 1997; 336 ([see comments]): 1697-1703 Crossref PubMed Scopus (908) Google Scholar and/or by promotion of favorable vessel remodeling after balloon angioplasty. 8 King III, S.B Williams D.O Chougule P Klein J.L Waksman R Hilstead R Macdonald J Anderberg K Crocker I.R Endovascular beta-radiation to reduce restenosis after coronary balloon angioplasty results of the beta energy restenosis trial (BERT). Circulation. 1998; 97: 2025-2030 Crossref PubMed Scopus (338) Google Scholar , 9 Condado J.A Waksman R Gurdiel O Espinosa R Gonzalez J Burger B Villoria G Acquatella H Crocker I.R Seung K.B Liprie S.F Long-term angiographic and clinical outcome after percutaneous transluminal coronary angioplasty and intracoronary radiation therapy in humans. Circulation. 1997; 96 ([see comments]): 727-732 Crossref PubMed Scopus (340) Google Scholar , 10 Waksman R Condado J.A Saucedo J.F Lanski A Popma J.J Intracoronary radiation Post PTCA prevents Late arterial constriction QCA analysis (abstr). J Am Coll Cardiol. 1998; 31: 222A Abstract Full Text PDF Google Scholar Recent clinical studies with γ or β radiation in humans have demonstrated a significant reduction in restenosis rates without complications or adverse effects related to radiation itself, with follow-up periods now approaching 2 years. 7 Teirstein P.S Massullo V Jani S Popma J.J Mintz G.S Russo R.J Schatz R.A Guarneri E.M Steuterman S Morris N.B Leon M.B Tripuraneni P Catheter-based radiotherapy to inhibit restenosis after coronary stenting. N Engl J Med. 1997; 336 ([see comments]): 1697-1703 Crossref PubMed Scopus (908) Google Scholar , 8 King III, S.B Williams D.O Chougule P Klein J.L Waksman R Hilstead R Macdonald J Anderberg K Crocker I.R Endovascular beta-radiation to reduce restenosis after coronary balloon angioplasty results of the beta energy restenosis trial (BERT). Circulation. 1998; 97: 2025-2030 Crossref PubMed Scopus (338) Google Scholar Using cross-sectional analysis by intravascular ultrasound (IVUS), Teirstein and colleagues 7 Teirstein P.S Massullo V Jani S Popma J.J Mintz G.S Russo R.J Schatz R.A Guarneri E.M Steuterman S Morris N.B Leon M.B Tripuraneni P Catheter-based radiotherapy to inhibit restenosis after coronary stenting. N Engl J Med. 1997; 336 ([see comments]): 1697-1703 Crossref PubMed Scopus (908) Google Scholar observed a 64% decrease in overall intimal hyperplasia volume within stents treated with iridium-192 (Ir-192) compared with stent segments not receiving radiation. Little is known about the magnitude, direction, and overall distribution of neointimal tissue inside stents and at reference segments after radiation therapy. In this report, plaque area changes as a function of position in the treated segment were compared among 3 patients treated either with or without Ir-192 (γ)- radiation.

Discussion

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Cite This Study

Limpijankit et al. (1999) conducted a case report in Coronary stenting and restenosis (n=3). Iridium-192 (γ)-radiation vs. Without Ir-192 (γ)-radiation was evaluated on Plaque area changes as a function of position in the treated segment.

synapsesocial.com/papers/6aa59019e8c87b1c7e395dd3 https://doi.org/10.1016/s0002-9149(99)00449-x

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Intravascular ultrasound volumetric assessment of intimal hyperplasia in stents treated with intracoronary radiation

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Intravascular ultrasound volumetric assessment of intimal hyperplasia in stents treated with intracoronary radiation

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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