Geographic Miss

Parikh, Suhrid; Nori, Dattatreyudu; Tripuraneni, Prabhakar

doi:10.1161/01.cir.101.21.2467

Cited by 168 publications

(33 citation statements)

References 21 publications

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“…The volumetric analysis on intracoronary ultrasound showed that the growth of neointimal tissue was mild after 6 months of clinical follow-up, a result similar to that of other studies 32 . The growth of the vessel (+21.4±27.8 mm 3 ) observed after 180 days of treatment suggests that intracoronary beta radiation induced a positive remodeling of the arterial wall, characterized by an "accommodative" process of the plaque (correlation of the increase in the ∆ external elastic membrane vs D plaque, r=0.963, P < 0.01), preserving the volume of the in-stent lumen.…”

Section: Discussionsupporting

confidence: 88%

“…Compared with gamma radiation, beta radiation has a smaller depth of penetration, minimizing the exposure to radiation for patients and operators, requiring, therefore, less radioprotection. However, the rapid decrease in the dose of beta radiation within 2-5mm of depth is associated with a less homogeneous release of the dose 32 . In addition, the "shield effect" produced by the rods of the stent could be associated with an attenuation in the radiation dose through its rods greater than 15% 36 .…”

Section: Discussionmentioning

confidence: 99%

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Braquiterapia intracoronariana. Tratamento da reestenose intra-stent com o sistema Beta-Cath: experiência inicial na América Latina

Muñoz

Feres

Abizaid

et al. 2004

Arq. Bras. Cardiol.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Braquiterapia intracoronariana. Tratamento da reestenose intra-stent com o sistema Beta-Cath: experiência inicial na América Latina

Muñoz

Feres

Abizaid

et al. 2004

Arq. Bras. Cardiol.

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“…The IRS was defined as the area encompassed by the 2 gold markers of the radiation source train. 5 It was identified on angiography by contrast injection with the source in place.…”

Section: Angiographic Analysismentioning

confidence: 99%

High-Dose Intravascular β-Radiation After De Novo Stent Implantation Induces Coronary Artery Spasm

et al. 2002

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Background-Intracoronary brachytherapy is effective in preventing restenosis after coronary interventions. However, in vitro and animal studies have shown that irradiation produces immediate and sustained endothelial dysfunction. This study assesses the clinical relevance of impaired vasomotoric function induced by brachytherapy. Methods and Results-We analyzed the occurrence of postradiation coronary artery spasms in 1 animal study and 2 clinical trials investigating the effects of high-dose intracoronary ␤-radiation after de novo coronary artery stenting. Irradiated segments (IRSs) proximal and distal to the stent were studied by quantitative coronary angiography after stenting, after radiation, and at the end of the procedure. There was an 67% overall incidence of coronary artery spasm in the IRSs immediately after ␤-radiation compared with 9% after sham treatment (PϽ0.001). Whereas in most cases this phenomenon was only minor or moderate, in 12 cases, 4 (22%) animals and 8 (28%) patients, severe coronary spasm (Ͼ90% diameter stenosis) with significant ECG-changes or hemodynamic instability was observed. Relief of spasms was protracted (mean time until complete relief of spasm 423Ϯ122 seconds) and required repetitive intracoronary administration of nitroglycerin (mean dose: 1.2Ϯ0.6 mg). Conclusions-Vasoconstriction is a frequent reaction of coronary arteries after high-dose intracoronary ␤-radiation, necessitating repetitive administration of vasodilators.

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“…10 -12 It is anticipated this rate will be reduced by optimization of antiplatelet regimens (and hence a reduction in stent thrombosis), adjustments to the dose prescription, and more meticulous attention to irradiating the entire ballooninjured segment (to reduce the occurrence of "geographic miss"). 16 However, among the 150 000 patients who undergo treatment for in-stent restenosis annually in the United States, there remains a population of patients who will encounter recurrent restenosis despite optimal intracoronary brachytherapy.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome of Patients Treated With Repeat Percutaneous Coronary Intervention After Failure of γ-Brachytherapy for the Treatment of In-Stent Restenosis

et al. 2002

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Background-Although 192 Ir intracoronary brachytherapy has been demonstrated to dramatically reduce the recurrence of in-stent restenosis, up to 24% of these patients will still require repeat target-vessel revascularization. The short-and long-term outcomes of repeat percutaneous intervention in this population have not been characterized. Methods and Results-Analysis was performed of all patients enrolled in the GAMMA-I and GAMMA-II brachytherapy trials who underwent repeat percutaneous target lesion revascularization (TLR) because of restenosis. Subjects were divided into 2 cohorts: those who had received 192 Ir brachytherapy and those randomized to placebo. Forty-five (17.6%) of a total of 256 patients whose index treatment was intracoronary radiation therapy and 36 (29.8%) of 121 patients whose index treatment was placebo required repeat percutaneous TLR. The mean time to this first TLR was 295Ϯ206 days in the irradiated group and 202Ϯ167 days in the placebo group (Pϭ0.03). Acute procedural success occurred in 100% of irradiated patients and 94% of placebo controls (Pϭ0.19). After the first TLR, a subsequent TLR was required in 15 (33.3%) of 45 brachytherapy patients versus 17 (47.2%) of 36 placebo failure patients (Pϭ0.26). There was no significant difference in time to second TLR between the 2 groups. Other long-term major adverse event rates in both groups were comparable to those of other contemporary angioplasty/stenting series. Conclusions-In those patients who "fail"192 Ir intracoronary brachytherapy for in-stent restenosis, treatment with 192 Ir delays the time to first TLR. Additionally, repeat percutaneous intervention in these patients is safe and efficacious in the short term, with acceptable long-term results.

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Geographic Miss

Abstract: These data support the hypothesis that the combination of injury and low-dose beta-radiation induces deleterious outcome.

Cited by 168 publications

References 21 publications

Braquiterapia intracoronariana. Tratamento da reestenose intra-stent com o sistema Beta-Cath: experiência inicial na América Latina

Braquiterapia intracoronariana. Tratamento da reestenose intra-stent com o sistema Beta-Cath: experiência inicial na América Latina

High-Dose Intravascular β-Radiation After De Novo Stent Implantation Induces Coronary Artery Spasm

Long-Term Outcome of Patients Treated With Repeat Percutaneous Coronary Intervention After Failure of γ-Brachytherapy for the Treatment of In-Stent Restenosis

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