Early time course of neointima formation and vascular remodelling following percutaneous coronary intervention and vascular brachytherapy of in-stent restenotic lesions as assessed by intravascular ultrasound analysis

• Published in: Clinical research in cardiology 2005-04, Vol.94 (4), p.239-246
• Main Authors: Zimmermann, A, Pöllinger, B, Rieber, J, König, A, Erhard, I, Krötz, F, Sohn, H-Y, Kantlehner, R, Haimerl, W, Dühmke, E, Leibig, M, Theisen, K, Klauss, V, Schiele, T M
• Format: Article
• Language: English
• Subjects: Angiography; Angioplasty; Angioplasty, Balloon, Coronary - methods; Blood vessels; Brachytherapy; Brachytherapy - methods; Combined Modality Therapy; Coronary Vessels - diagnostic imaging; Coronary Vessels - growth & development; Coronary Vessels - surgery; Female; Graft Occlusion, Vascular - diagnostic imaging; Graft Occlusion, Vascular - prevention & control; Humans; Hyperplasia; Implantation; Implants; Lesions; Male; Middle Aged; Preservation; Radiation therapy; Recovery of Function; Restenosis; Risk Assessment - methods; Risk Factors; Stents; Surgical implants; Time Factors; Treatment Outcome; Tunica Intima - diagnostic imaging; Ultrasonic imaging; Ultrasonography, Interventional - methods; Ultrasound
• ISSN: 0300-5860; 1861-0684; 1435-1285; 1861-0692
• DOI: 10.1007/s00392-005-0204-7

In-stent restenosis (ISR) represents the major limitation of stent implantation. Treatment, although of relative technical ease, is unsatisfactory due to a high incidence of recurrent restenosis. Vascular brachytherapy (VBT) has emerged as a powerful adjunct therapeutic modality to treat ISR. Inhibition of neointima formation has been regarded as the relevant mechanism of action. Yet, positive remodelling has been suspected as another contributing factor. Since only very few precise analyses of the extent, distribution and time course of the respective mechanims exist, the goal of the present study was to describe the changes of the vessel geometry at the target lesion and at the reference site following angioplasty and VBT of ISR in 42 patients by means of quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) before and after the index procedure and at the 3 and 6 month follow-up. By QCA the acute lumen gain measured 2.2+/-0.8 mm, the late lumen loss at 3 months was 0.1+/-0.5 mm and at 6 months 0.4+/-0.7 mm. By IVUS luminal cross-sectional area increased from 1.5+/-1.2 mm(2) to 7.9+/-1.9 mm(2) (p