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Relationship between neointimal regrowth and mechanism of acute lumen gain during the treatment of in‐stent restenosis with or without supplementary intravascular radiation
Author(s) -
Morino Yoshihiro,
Limpijankit Thosaphol,
Honda Yasuhiro,
Somrantin Manoon,
Waksman Ron,
Bonneau Heidi N.,
Yock Paul G.,
Mintz Gary S.,
Fitzgerald Peter J.
Publication year - 2003
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.10405
Subject(s) - medicine , restenosis , intravascular ultrasound , stent , intimal hyperplasia , lumen (anatomy) , neointima , angioplasty , neointimal hyperplasia , balloon , brachytherapy , radiology , cardiology , radiation therapy , smooth muscle
We investigated whether neointimal regrowth is related to the mechanism of acute lumen gain during the treatment of in‐stent restenosis (ISR) lesions both with and without adjunct intravascular brachytherapy. From the WRIST (Washington Radiation for In‐Stent Restenosis Trial) cohort, 54 ISR patients ( 192 Ir, 29; placebo, 25) were treated with nonrepeat stenting percutaneous interventions (excimer laser, rotational atherectomy, and/or balloon angioplasty) prior to 192 Ir or placebo therapy. Using Simpson's method, serial volumetric intravascular ultrasound (IVUS) analyses (pre‐ and posttreatment and 6‐month follow‐up) were analyzed to obtain stent, lumen, and intimal hyperplasia (IH) volumes that were then adjusted for stent length to create stent, lumen, and IH volume indexes. In the placebo group, the acute reduction of neointima (1.6 ± 1.4 mm 3 /mm) was counteracted by intimal regrowth (2.1 ± 1.7 mm 3 /mm). The amount of intimal regrowth correlated directly with the intimal reduction due to the intervention (r = 0.76; P < 0.001), but not with the amount of additional stent expansion. In the 192 Ir‐treated group, intimal regrowth was significantly less than in the placebo group (−0.3 ± 0.1 vs. 2.1 ± 1.7 mm 3 /mm; P < 0.001) despite a similar initial intimal reduction (1.3 ± 0.9 vs. 1.6 ± 1.4 mm 3 /mm; P = NS). No correlation was found between intimal reduction at the time of the procedure and intimal regrowth in the 192 Ir group. In this study, neointimal regrowth following treatment of ISR lesions correlates directly with the extent of acute intimal volume reduction, but not with the extent of additional stent expansion. This relation is not seen in ISR segments treated with radiation, where intimal regrowth is substantially inhibited. Cathet Cardiovasc Intervent 2003;58:162–167. © 2003 Wiley‐Liss, Inc.