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Quantitative angiographic methods for appropriate end-point analysis , edge-effect evaluation , and prediction of recurrent restenosis after coronary brachytherapy with gamma irradiation . OBJECTIVES The study was done to investigate the relationship between clinical restenosis and the relative angiographic location of the recurrent restenotic lesion , after treatment of in-stent restenosis with vascular brachytherapy in the Washington Radiation for In-Stent Restenosis Trial ( WRIST ) . BACKGROUND Intracoronary radiation therapy reduces recurrence of in-stent restenosis . We investigated the above objective in patients enrolled in WRIST . METHODS The WRIST study randomized 130 patients to double-blinded therapy with gamma irradiation ( iridium-192 [ ( 192 ) Ir ] ) versus placebo after interventional treatment of diffuse in-stent restenosis . After the intervention and at follow-up , three vessel segments were individually analyzed with quantitative coronary angiography : 1 ) the " stent , " 2 ) the " radiation ribbon , " and 3 ) the " ribbon+margin " segment ( including 5 mm on either end of the injured or radiation-ribbon segment ) . Receiver operator curves ( ROC ) were used to assess the value of the follow-up percent diameter stenosis ( DS ) for each of the three analyzed segments in predicting target vessel revascularization ( TVR ) . RESULTS ( 192 ) Ir reduced recurrent restenosis ( 23.7 % vs. 60.7 % , p < 0.001 ) and the length of recurrent restenosis ( 8.99 +/- 4.34 mm vs. 17.54 +/- 10.48 mm , p < 0.001 ) at follow-up compared to placebo . Isolated stent edge ( 3.4 % ) and ribbon edge ( 1.7 % ) restenoses were infrequent in both groups . The best angiographic surrogate of TVR was the 50 % follow-up DS obtained from the ribbon+margin analysis ( ROC area 0.806 ) . CONCLUSIONS In WRIST , not only was ( 192 ) Ir therapy effective in reducing restenosis , but it also reduced the lesion length of treatment failures by 50 % , and it was not associated with edge proliferation . The restenosis rate obtained from the vessel segment inclusive of the dose fall-off zones was the best correlate of TVR and should become a standard analysis site in all vascular brachytherapy trials .
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Intervention_Physical
coronary brachytherapy
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Intervention_Physical
vascular brachytherapy
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Intervention_Physical
Intracoronary radiation therapy
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Intervention_Physical
double-blinded therapy with gamma irradiation ( iridium-192 [ ( 192 ) Ir ] )
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Intervention_Control
placebo
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Intervention_Surgical
interventional treatment of diffuse in-stent restenosis
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Intervention_Physical
( 192 ) Ir therapy
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Outcome_Mental
end-point analysis , edge-effect evaluation
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Outcome_Physical
prediction of recurrent restenosis
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Outcome_Physical
recurrent restenosis
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Outcome_Physical
length of recurrent restenosis
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Outcome_Physical
Isolated stent edge
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Outcome_Physical
ribbon edge
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Outcome_Physical
restenoses
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Participant_Condition
coronary brachytherapy with gamma irradiation .