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Edge Stenosis After Intracoronary Radiotherapy

2001; Lippincott Williams & Wilkins; Volume: 103; Issue: 17 Linguagem: Inglês

10.1161/01.cir.103.17.2219

1524-4539

Han‐Soo Kim, Ron Waksman, Marc Kollum, Balram Bhargava, Kenneth M. Kent, Gary S. Mintz, Frank D. Kolodgie, Renu Virmani,

Chemotherapy-induced cardiotoxicity and mitigation

HomeCirculationVol. 103, No. 17Edge Stenosis After Intracoronary Radiotherapy Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBEdge Stenosis After Intracoronary Radiotherapy Angiographic, Intravascular, and Histological Findings Han-Soo Kim, Ron Waksman, Marc Kollum, Balram Bhargava, Kenneth M. Kent, Gary S. Mintz, Frank D. Kolodgie and Renu Virmani Han-Soo KimHan-Soo Kim From the Cardiovascular Research Institute, Washington Hospital Center, Washington, DC (H.-S.K., R.W., M.K., B.B., K.M.K., G.S.M.), and the Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC (F.D.K., R.V.). , Ron WaksmanRon Waksman From the Cardiovascular Research Institute, Washington Hospital Center, Washington, DC (H.-S.K., R.W., M.K., B.B., K.M.K., G.S.M.), and the Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC (F.D.K., R.V.). , Marc KollumMarc Kollum From the Cardiovascular Research Institute, Washington Hospital Center, Washington, DC (H.-S.K., R.W., M.K., B.B., K.M.K., G.S.M.), and the Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC (F.D.K., R.V.). , Balram BhargavaBalram Bhargava From the Cardiovascular Research Institute, Washington Hospital Center, Washington, DC (H.-S.K., R.W., M.K., B.B., K.M.K., G.S.M.), and the Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC (F.D.K., R.V.). , Kenneth M. KentKenneth M. Kent From the Cardiovascular Research Institute, Washington Hospital Center, Washington, DC (H.-S.K., R.W., M.K., B.B., K.M.K., G.S.M.), and the Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC (F.D.K., R.V.). , Gary S. MintzGary S. Mintz From the Cardiovascular Research Institute, Washington Hospital Center, Washington, DC (H.-S.K., R.W., M.K., B.B., K.M.K., G.S.M.), and the Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC (F.D.K., R.V.). , Frank D. KolodgieFrank D. Kolodgie From the Cardiovascular Research Institute, Washington Hospital Center, Washington, DC (H.-S.K., R.W., M.K., B.B., K.M.K., G.S.M.), and the Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC (F.D.K., R.V.). and Renu VirmaniRenu Virmani From the Cardiovascular Research Institute, Washington Hospital Center, Washington, DC (H.-S.K., R.W., M.K., B.B., K.M.K., G.S.M.), and the Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC (F.D.K., R.V.). Originally published1 May 2001https://doi.org/10.1161/01.CIR.103.17.2219Circulation. 2001;103:2219–2220A 73-year-old hypertensive, dyslipidemic man with known complex coronary artery disease has had operative revascularization twice in the last 10 years. He has also undergone multiple angioplasty procedures on the saphenous vein graft (SVG) to the obtuse marginal (OM) and right coronary arteries. The left internal mammary artery conduit to the left anterior descending artery remains patent.The SVG to the OM was treated for in-stent restenosis with Excimer laser angioplasty, and the patient was included in the SVG Washington Radiation for In-Stent restenosis Trial (WRIST) protocol. No additional stent was placed. After the intervention, the patient received intracoronary γ-radiation therapy (iridium-192 ribbon×9 seeds; 35 mm; Best Medical International). The prescribed dose was 15 Gy to a distance 2.0 mm from the surface of the source. The patient received Plavix (clopidogrel 250 mg BID) for 1 month and is now taking aspirin (325 mg) every day.He did well until recently, when he presented with exertional chest discomfort. Thallium stress testing demonstrated lateral wall ischemia. An angiogram taken 6 months after γ-radiation showed focal edge stenosis at the proximal margin of the stent in the SVG to OM (Figure 1). Intravascular ultrasound pullback at 0.5 mm/s (3.2 F, 30 MHz, Boston Scientific/CVIS) showed a soft concentric plaque (Figure 2), which was subjected to directional atherectomy (DVI Inc) and balloon angioplasty. Two pieces of the edge restenotic tissue were analyzed histologically; they showed typical hypocellularity or acellularity after brachytherapy (Figure 3).Download figureDownload PowerPoint Figure 1. Angiogram taken 6 months after γ-radiation showed focal edge stenosis at the proximal margin of the stent in the SVG to OM.Download figureDownload PowerPoint Figure 2. Intravascular ultrasound images taken 6 months after γ-radiation and 1 mm apart show soft plaque.Download figureDownload PowerPoint Figure 3. Photomicrographs of serial histological sections of an atherectomy specimen retrieved from the proximal edge of the stent 6 months after brachytherapy (magnification ×50). A, Section stained using Movat pentachrome methods shows a predominant blue-green–colored proteoglycan-rich matrix with amorphous brownish material resembling fibrin. B, Immunohistochemical identification of platelets using an anti-CD61 antibody; note the persistent platelet deposition within the lesion. C, Fibrin II staining showing diffuse immunoreactivity. D and E, Identification of smooth muscle cells and macrophages by anti-α-actin and anti-CD68 antibodies, respectively. Smooth muscle cells are the predominant cell type. F, Polarization microscopy after picrosirius red staining shows a mixture of collagen types I (yellow-red) and III (green).FootnotesCorrespondence to Ron Waksman, MD, Cardiovascular Research Institute, 110 Irving St, NW, Suite 4B-1, Washington, DC 20010. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By (2004) Laser Literature Watch, Photomedicine and Laser Surgery, 10.1089/1549541041438588, 22:3, (261-276), Online publication date: 1-Jun-2004. Bhargava B, Karthikeyan G and Tripuraneni P (2004) Intravascular Brachytherapy, American Journal of Cardiovascular Drugs, 10.2165/00129784-200404060-00007, 4:6, (385-394), . Tripuraneni P (2002) Coronary artery radiation therapy for the prevention of restenosis after percutaneous coronary angioplasty, II: Outcomes of clinical trials, Seminars in Radiation Oncology, 10.1053/srao.2002.28659, 12:1, (17-30), Online publication date: 1-Jan-2002. May 1, 2001Vol 103, Issue 17 Advertisement Article InformationMetrics Copyright © 2001 by American Heart Associationhttps://doi.org/10.1161/01.CIR.103.17.2219 Originally publishedMay 1, 2001 PDF download Advertisement