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KMID : 0368120040340090856
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Korean Circulation Journal
2004 Volume.34 No. 9 p.856 ~ p.864
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Late Intravascular Ultrasound Findings of Patients Treated with Brachytherapy for Diffuse In-Stent Restenosis
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이봉기/Lee BK
홍명기/이명준/김성두/이세환/박창범/양태현/김민규/이승환/김영학/오승준/문대혁/이철환/김재중/박성욱/박승정/Hong MK/Lee MJ/Kim SD/Lee SW/Park CB/Yang TH/Kim MK/Lee SW/Kim YH/Oh SJ/Moon DH/Lee CW/Kim JJ/Park SW/Park SJ
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Abstract
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Background and Objectives：The long-term effects of β-irradiation on intimal hyperplasia (IH) within the stented segment and vessel, and the lumen dimensions of non-stented adjacent segments, have not been sufficiently evaluated in patients with ISR. The long-term (24 months) effects of β-irradiation (188Re-MAG3-filled balloon) were evaluated using intravascular ultrasound (IVUS) in patients with in-stent restenosis (ISR).
Subjects and Methods：A two-year follow-up IVUS was performed in 30 patients with patent ISR segments at the 6-monthly follow-up angiography. Serial IVUS images were acquired at 5 equidistant intra-stent sites and 3 different reference segment sites (1, 2 and 4 mm from stent margin).
Results：The mean intra-stent IH area and IH burden significantly increased between 6 and 24 months-from 2.1±1.1 to 2.6±1.4 mm2 (p<0.001) and from 26±10 to 33±14% (p<0.001), respectively. There were significant decreases in the 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±2.3mm2, p=0.021) within the distal reference segments between 6 and 24 months. Target lesion revascularization (TLR) was performed between 6 and 24 months in 6 patients (20%) following the β-irradiation therapy. There were no significant differences between the TLR and non-TLR groups, with the exception of a smaller minimum lumen CSA at 24 months in the TLR group.
Conclusion：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 with a smaller minimum lumen area.
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KEYWORD
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