on October 7, 2002
Published online before print October 7, 2002, doi: 10.1161/01.CIR.0000036367.17043.03
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Submitted on April 18, 2002
From the Center for Research in Cardiovascular Interventions, Stanford University Medical Center, Stanford, Calif (Y.M., H.K., A.T., A.H.M.H., P.G.Y., Y.H., P.J.F.); Emory University, Atlanta, Ga (T.F., I.C.); Institut de Cardiologie de Montreal, Montreal, Canada (R.B.); Cardiovascular Research Foundation, New York, NY (A.J.L.); University of Maryland Medical System, Baltimore, Md (W.K.L., M.S.); and Highland Consulting Inc, San Jose, Calif (H.N.B.). * To whom correspondence should be addressed. E-mail: ivus{at}crci.stanford.edu.
Background—Observations from previous intracoronary radiation therapy trials noted a considerable discrepancy between the prescribed radiation dose and the dose actually delivered. The aims of this study were to investigate the effect of actual delivered dose on vascular changes and to test the appropriateness of the current dose prescription. Methods and Results—Serial volumetric intravascular ultrasound (IVUS) analysis was performed in 30 in-stent restenosis cases treated with a 40-mm 90Sr/Y source train. The fixed dose was prescribed at 2 mm from the centerline of the source train (18.4 Gy at 2 mm for reference diameter Conclusions—The current dose-prescription protocol of 90Sr/Y radiation to native in-stent restenosis lesions may provide substantial inhibition of neointimal reproliferation regardless of the actual delivered dose intensity.
Revised on August 16, 2002
Accepted on August 16, 2002
Delivered Dose and Vascular Response After ß-Radiation for In-Stent Restenosis. Retrospective Dosimetry and Volumetric Intravascular Ultrasound Analysis
Yoshihiro Morino MD,
3.35 mm and 23 Gy for diameter 
3.36 mm). Only stent segments with full radiation coverage and device injury were enrolled and divided into 2-mm-long subsegments (n=202). DS90EEM (the minimum dose absorbed by 90% of the external elastic membrane surface) was calculated as the delivered dose corresponding to each segment, assuming that the radiation catheter occupied the same position in the vessel as the IVUS catheter. Mean DS90EEM of 23.5±5.82 Gy (range 12.3 to 41.7 Gy) was delivered to these subsegments. Overall, intimal hyperplasia volume remained constant from postintervention to follow-up (2.23±1.10 to 2.32±1.09 mm3/m; P=NS). Regression analysis revealed there was no correlation between delivered dose intensity and changes in intimal hyperplasia volume. No particular dose-dependent complications were appreciated in this delivered dose range.
Key words: restenosis • radioisotopes • stents • coronary disease
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