| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
|
|
|
|
|||||||||||||
|
|
|||||||||||||||
radiation
a Thoraxcenter Bd 418, University Hospital Dijkzigt, Dr Molewaterplein 40, 3015 GD Rotterdam,
The Netherlands, b The
Daniel den Hoed, Cancer Center, Rotterdam, The Netherlands
Correspondence to: Professor Serruys email: serruys{at}card.azr.nl
Accepted 12 October
1999
OBJECTIVE
To evaluate the healing of balloon induced
coronary artery dissection in individuals who have received 
radiation treatment and to propose a new intravascular ultrasound
(IVUS) dissection score to facilitate the comparison of dissection
through time.
DESIGNRetrospective study.
SETTINGTertiary referral centre.
PATIENTS31 patients with stable angina pectoris,
enrolled in the beta energy restenosis trial (BERT-1.5), were included.
After excluding those who underwent stent implantation, the evaluable
population was 22 patients.
INTERVENTIONSBalloon angioplasty and intracoronary
radiation followed by quantitative coronary angiography (QCA) and IVUS.
Repeat QCA and IVUS were performed at six month follow up.
MAIN OUTCOME MEASURESQCA and IVUS evidence of healing of
dissection. Dissection classification for angiography was by the
National Heart Lung Blood Institute scale. IVUS proven dissection was
defined as partial or complete. The following IVUS defined
characteristics of dissection were described in the affected coronary
segments: length, depth, arc circumference, presence of flap, and
dissection score. Dissection was defined as healed when all features of
dissection had resolved. The calculated dose of radiation received by
the dissected area in those with healed versus non-healed dissection
was also compared.
RESULTSAngiography (type A = 5, B = 7, C = 4) and
IVUS proven (partial = 12, complete = 4) dissections were seen in
16 patients following intervention. At six month follow up, six and
eight unhealed dissections were seen by angiography (A = 2, B = 4)
and IVUS (partial = 7, complete = 1), respectively. The mean IVUS
dissection score was 5.2 (range 3-8) following the procedure, and 4.6 (range 3-7) at follow up. No correlation was found between the dose
prescribed in the treated area and the presence of unhealed dissection.
No change in anginal status was seen despite the presence of unhealed dissection.
CONCLUSION radiation appears to alter the normal
healing process, resulting in unhealed dissection in certain
individuals. In view of the delayed and abnormal healing observed, long
term follow up is indicated given the possible late adverse effects of
radiation. Although in this cohort no increase in cardiac events
following coronary dissections was seen, larger populations are needed
to confirm this phenomenon. Stenting of all coronary dissections may be
warranted in patients scheduled for brachytherapy after balloon angioplasty.
This article has been cited by other articles:
|
|
 |
|
  G. G.L. Biondi-Zoccai, P. Agostoni, G. M. Sangiorgi, F. Airoldi, J. Cosgrave, A. Chieffo, R. Barbagallo, C. Tamburino, G. Vittori, E. Falchetti, et al. Incidence, predictors, and outcomes of coronary dissections left untreated after drug-eluting stent implantation Eur. Heart J., March 1, 2006; 27(5): 540 - 546. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Alfonso Residual coronary dissections after drug-eluting stenting: the good, the bad, and the ugly Eur. Heart J., March 1, 2006; 27(5): 503 - 505. [Full Text] [PDF]
|
|
|
|
|
|
M. Degertekin, P. A. Lemos, C. H. Lee, K. Tanabe, J.E. Sousa, A. Abizaid, E. Regar, G. Sianos, W. J. van der Giessen, P. J. de Feyter, et al. Intravascular ultrasound evaluation after sirolimus eluting stent implantation for de novo and in-stent restenosis lesions Eur. Heart J., January 1, 2004; 25(1): 32 - 38. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Tanabe, P. W. Serruys, E. Grube, P. C. Smits, G. Selbach, W. J. van der Giessen, M. Staberock, P. de Feyter, R. Muller, E. Regar, et al. TAXUS III Trial: In-Stent Restenosis Treated With Stent-Based Delivery of Paclitaxel Incorporated in a Slow-Release Polymer Formulation Circulation, February 4, 2003; 107(4): 559 - 564. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.W. Serruys, G. Sianos, W. van der Giessen, H.J.R.M. Bonnier, P. Urban, W. Wijns, E. Benit, M. Vandormael, R. Dorr, C. Disco, et al. Intracoronary {beta}-radiation to reduce restenosis after balloon angioplasty and stenting. The Beta Radiation In Europe (BRIE) study Eur. Heart J., September 1, 2002; 23(17): 1351 - 1359. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. Serruys, M. Degertekin, K. Tanabe, A. Abizaid, J. E. Sousa, A. Colombo, G. Guagliumi, W. Wijns, W. K. Lindeboom, J. Ligthart, et al. Intravascular Ultrasound Findings in the Multicenter, Randomized, Double-Blind RAVEL (RAndomized study with the sirolimus-eluting VElocity balloon-expandable stent in the treatment of patients with de novo native coronary artery Lesions) Trial Circulation, August 13, 2002; 106(7): 798 - 803. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Regar, K. Kozuma, G. Sianos, V.L.M.A. Coen, W.J. van der Giessen, D. Foley, P. de Feyter, B. Rensing, P. Smits, J. Vos, et al. Routine intracoronary beta-irradiation. Acute and one year outcome in patients at high risk for recurrence of stenosis Eur. Heart J., July 1, 2002; 23(13): 1038 - 1044. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. S. Mintz, N. J. Weissman, and P. J. Fitzgerald Intravascular Ultrasound Assessment of the Mechanisms and Results of Brachytherapy Circulation, September 11, 2001; 104(11): 1320 - 1325. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
