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23rd Annual Congress ot the European Society of Cardiology (ESC), September 2001, Stockholm, Sweden
- Geographic miss increases the risk of late target vessel thrombosis after intracoronary brachytherapy with beta radiation
- W. Auch-Schwelk (1), S. Moesseler (1), B. Schopohl (2), K. Manegold (2), K. Pistorius (1), A.M. Zeiher (1), P. Serruys (3), D. Baumgart (4), S. Silber (5), P. Urban (6)
1, JW-Goethe University Frankfurt, Cardiology Dept., Frankfurt, Germany
2, JW-Goethe University, Radiation Therapy, Frankfurt, Germany
3, Heart Center Rotterdam, Rotterdam, Netherlands
4, Universitätsklinikum Essen, Cardiology Dept., Essen, Germany
5, Müller Hospital, Munich, Germany
6, Centre Hospitalier Universitaire, Lausanne, Switzerland
- Eur Heart J 22, Abstract suppl., 391, (2001)
Introduction: Incomplete radiation of the balloon-injured segment (geographic miss = GM) may promote restenosis at the edges of the treated segment after intracoronary brachytherapy with beta radiation (ICBT). This may limit the clinical benefits of the treatment. The present study investigates the influence of GM on the clinical and angiographic outcome after 6 months. 1036 patients (pts.) were treated in 47 European Centers with a 90Sr/90Y Beta radiation source (Novoste Beta-Cath) of either 30, 40, or 60 mm length after successful coronary angioplasty. The pts. were classified by the operators to either having received complete coverage of the balloon injury zone (CC) by the radiation source or GM.
Results: Geographic miss was notified in 67 (6.5%) out of 1036 pts. 76.7 (GM) and 77.6% (CC) of the lesions were instent restenosis. Lesions tended to be longer in GM (22.3 ± 2.5 mm) than in CC (19 ± 12 mm). Technical success was reduced in GM (77.5%) as compared to CC (96.7%). GM occurred more frequent with the use of the 30 mm (26/182 pts = 14%) than with longer radiation sources (40 mm: 46/869 pts = 5%; 60 mm 1/42 pts = 5%). New stents were placed in 43.8 (GM) and 29% (CC) of pts. In-hospital events were comparable (GM: 3%; CC: 1.9%). Currently 6 month follow-up is available in 67% (GM) and 52% (CC) of pts. (table).Clinical and angiographic follow-up 6 months after ICBT:
Conclusions: GM cannot be completely avoided in the broad application of
ICBT. It occurs less frequently with the use of longer radiation sources. Overall
clinical outcome (MACE) is not influenced by GM despite a trend towards a
higher restenosis rate. However, GM may increase the risk for late target
vessel thrombosis. New stent implantation and reduced technical success may
contribute to this risk and to the occurrence of GM.
