Key result
Intracoronary radiation is linked to a ~22% rate of intraluminal echolucent tissue at 6 months.
Why the study?
Recent trials in humans have provided insight into consequences of intracoronary radiation, but new intravascular ultrasound observations of echolucent tissue at six months require description.
Cohort (n=198)
Answers are grounded in this paper and cite their sources.
Black hole' on IVUS after brachytherapy is hypothesis-generating; its clinical significance and outcomes association remain to be clarified.
AIMS: Recent trials in humans have given us insight into some of the consequences of intracoronary radiation. The authors describe a new observation noted on intravascular ultrasound: that of intraluminal echolucent tissue, dubbed the 'black hole', noted at six-month follow-up. METHODS AND RESULTS: One hundred and twenty-eight consecutive patients enrolled in brachytherapy protocols were analyzed. The control group (C) consisted of individuals who underwent percutaneous transluminal coronary angioplasty with (n = 48) and without (n = 22) stent implantation. Radiation groups included those who underwent low activity (LA) (n = 18), high activity (HA) (n = 26) and cold-end (CE) (n = 18) radioactive stenting. The Novoste Betacath (n = 39) and Guidant (n = 27) catheter-based radiation systems were also employed. At six-month follow-up echolucent tissue was identified in a total of 28 cases (22%). Angiographic restenosis occurred in 17 cases (61%). No echolucent tissue was seen in the control group or in the LA group. HA and CE radioactive stents were most commonly associated with echolucent tissue. Echolucent tissue was seen in all groups treated with catheter-based radiation with and without stenting. Pathology after atherectomy demonstrated smooth muscle cells scattered in extracellular matrix containing abundant proteoglycans and an absence of elastin and mature collagen. CONCLUSIONS: Echolucent tissue is common after radioactive stenting. It is composed of tissue rich in proteoglycans while poor in mature collagen and elastin.
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Kay et al. (2003) conducted a cohort in Coronary artery disease undergoing percutaneous intervention (n=198). Intracoronary radiation vs. PTCA with or without stent implantation (no radiation) was evaluated on Intraluminal echolucent tissue on intravascular ultrasound at 6 months. Intracoronary radiation was associated with the development of intraluminal echolucent tissue in 22% of treated patients at 6 months, compared to 0% in the non-radiated control group.
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