(Circulation. 2000;101:2467.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Geographic Miss
A Cause of Treatment Failure in Radio-Oncology Applied to Intracoronary Radiation Therapy
From the Thoraxcenter, Heartcenter, and Academisch Ziekenhuis Dijkzigt (M.S., M.A.C., K.K., I.P.K., W.J.v.d.G., J.M.R.L., P.S., P.W.S.), and the Daniel den Hoed Cancer Center (V.L.M.A.C., P.C.L.), Rotterdam, Netherlands.
Correspondence to P.W. Serruys, MD, PhD, Professor of Interventional Cardiology, Head of Department of Interventional Cardiology, Bd 408, Heartcenter, Academisch Ziekenhuis Rotterdam, Erasmus University, PO Box 2040, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands. E-mail serruys{at}card.azr.nl
Background—A recognized limitation of endovascular ß-radiation therapy is the development of new stenosis at the edges of the irradiated area. The combination of injury and low-dose radiation may be the precursor of this phenomenon. We translated the radio-oncological concept of "geographic miss" to define cases in which the radiation source did not fully cover the injured area. The aims of the study were to determine the incidence and causes of geographic miss and evaluate the impact of this inadequate treatment on the outcome of patients treated with intracoronary ß-radiation.
Methods and Results—We analyzed 50 consecutive patients treated with ß-radiation after percutaneous coronary intervention. The prescribed dose ranged between 12 and 20 Gy at 2 mm from the source axis. By means of quantitative coronary angiography, the irradiated segment (IRS) and both edges were studied before and after intervention and at 6-month follow-up. Edges that were injured during the procedure constituted the geographic miss edges. Twenty-two edges were injured during the intervention, mainly because of procedural complications that extended the treatment beyond the margins of the IRS. Late loss was significantly higher in geographic miss edges than in IRSs and uninjured edges (0.84±0.6 versus 0.15±0.4 and 0.09±0.4 mm, respectively; P<0.0001). Similarly, restenosis rate was significantly higher in the injured edges (10% within IRS, 40.9% in geographic miss edges, and 1.9% in uninjured edges; P<0.001).
Conclusions—These data support the hypothesis that the combination of injury and low-dose ß-radiation induces deleterious outcome.
Key Words: geographic miss • radioisotopes • balloon • angioplasty • stents • angiography • restenosis
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