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Background —We used serial volumetric (post-irradiation and follow-up) intravascular ultrasound (IVUS) to compare the effectiveness of γ-irradiation (192 Ir) in saphenous vein graft (SVG) versus native coronary artery in-stent restenosis (ISR).Methods and Results —The study population consisted of 47 patients with native coronary artery ISR from WRIST (Washington Radiation for In-Stent Restenosis Trial) and 31 patients with SVG ISR (12 from the WRIST and 19 from SVGWRIST). After irradiation and at 6-month follow-up, stent, lumen, and intimal hyperplasia (IH, stent minus lumen) areas were measured every 1 mm. ISR length was similar in the 2 groups (29±12 versus 29±14 mm,P =0.9). Post-intervention measurements of stent (280±154 versus 324±270 mm3 ,P =0.4), lumen (184±91 versus 214±172 mm3 ,P =0.3), and IH (96±77 versus 109±119 mm3 ,P =0.5) volumes were similar in the 2 groups. The post-intervention minimum lumen cross sectional areas tended to be smaller in native artery ISR lesions (4.7±1.7 versus 5.4±1.6 mm2 ,P =0.11). During follow-up, there was a slight increase in IH volume (9±38 mm3 ) in native artery ISR lesions and a slight decrease in IH volume in SVG ISR lesions (−9±32 mm3 ,P =0.0463). There was also a slight decrease in minimum lumen area in the native artery ISR lesions versus a slight increase in minimum lumen area in the SVG ISR lesions (−0.8±1.7 versus 0.2±1.1,P =0.0087). As a result, the follow-up minimum lumen area in native artery lesions was smaller than in SVG ISR lesions (4.1±2.1 mm2 versus 5.6±2.2 mm2 ,P =0.0067).Conclusion —γ-Irradiation with192 Ir brachytherapy appears to be as effective in SVGs as it is in native artery ISR lesions.

Comparative Efficacy of γ-Irradiation for Treatment of In-Stent Restenosis in Saphenous Vein Graft Versus Native Coronary Artery In-Stent Restenosis