Heart 2000;83:332-337 ( March )

Interventional cardiology surgery

Outcome from balloon induced coronary artery dissection after intracoronary  radiation I P Kay^a, M Sabate^a, G Van Langenhove^a, M A Costa^a, A J Wardeh^a, A L Gijzel^a, N V Deshpande^a, S G Carlier^a, V L M A Coen^b, P C Levendag^b, W Van der Giessen^a, P J de Feyter^a, P W Serruys^a

^a Thoraxcenter Bd 418, University Hospital Dijkzigt, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands, ^b The Daniel den Hoed, Cancer Center, Rotterdam, The Netherlands

Correspondence to: Professor Serruys email: serruys{at}card.azr.nl

Accepted 12 October 1999

OBJECTIVETo evaluate the healing of balloon induced coronary artery dissection in individuals who have received  radiation treatment and to propose a new intravascular ultrasound (IVUS) dissection score to facilitate the comparison of dissection through time.
DESIGNRetrospective study.
SETTINGTertiary referral centre.
PATIENTS31 patients with stable angina pectoris, enrolled in the beta energy restenosis trial (BERT-1.5), were included. After excluding those who underwent stent implantation, the evaluable population was 22 patients.
INTERVENTIONSBalloon angioplasty and intracoronary radiation followed by quantitative coronary angiography (QCA) and IVUS. Repeat QCA and IVUS were performed at six month follow up.
MAIN OUTCOME MEASURESQCA and IVUS evidence of healing of dissection. Dissection classification for angiography was by the National Heart Lung Blood Institute scale. IVUS proven dissection was defined as partial or complete. The following IVUS defined characteristics of dissection were described in the affected coronary segments: length, depth, arc circumference, presence of flap, and dissection score. Dissection was defined as healed when all features of dissection had resolved. The calculated dose of radiation received by the dissected area in those with healed versus non-healed dissection was also compared.
RESULTSAngiography (type A = 5, B = 7, C = 4) and IVUS proven (partial = 12, complete = 4) dissections were seen in 16 patients following intervention. At six month follow up, six and eight unhealed dissections were seen by angiography (A = 2, B = 4) and IVUS (partial = 7, complete = 1), respectively. The mean IVUS dissection score was 5.2 (range 3-8) following the procedure, and 4.6 (range 3-7) at follow up. No correlation was found between the dose prescribed in the treated area and the presence of unhealed dissection. No change in anginal status was seen despite the presence of unhealed dissection.
CONCLUSION radiation appears to alter the normal healing process, resulting in unhealed dissection in certain individuals. In view of the delayed and abnormal healing observed, long term follow up is indicated given the possible late adverse effects of radiation. Although in this cohort no increase in cardiac events following coronary dissections was seen, larger populations are needed to confirm this phenomenon. Stenting of all coronary dissections may be warranted in patients scheduled for brachytherapy after balloon angioplasty.


Keywords: dissection; intravascular ultrasound; angiography; coronary artery; brachytherapy; angioplasty

---

© 2000 by Heart
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Liu, X., Tsujita, K., Maehara, A., Mintz, G. S., Weisz, G., Dangas, G. D., Lansky, A. J., Kreps, E. M., Rabbani, L. E., Collins, M., Stone, G. W., Moses, J. W., Mehran, R., Leon, M. B. (2009). Intravascular Ultrasound Assessment of the Incidence and Predictors of Edge Dissections After Drug-Eluting Stent Implantation. J Am Coll Cardiol Intv 2: 997-1004 [Abstract] [Full Text]  
• Biondi-Zoccai, G. G.L., Agostoni, P., Sangiorgi, G. M., Airoldi, F., Cosgrave, J., Chieffo, A., Barbagallo, R., Tamburino, C., Vittori, G., Falchetti, E., Margheri, M., Briguori, C., Remigi, E., Iakovou, I., Colombo, A., on behalf of the RECIPE (Real-world Eluting-stent, (2006). Incidence, predictors, and outcomes of coronary dissections left untreated after drug-eluting stent implantation. Eur Heart J 27: 540-546 [Abstract] [Full Text]  
• Alfonso, F. (2006). Residual coronary dissections after drug-eluting stenting: the good, the bad, and the ugly. Eur Heart J 27: 503-505 [Full Text]  
• Degertekin, M., Lemos, P. A., Lee, C. H., Tanabe, K., Sousa, J.E., Abizaid, A., Regar, E., Sianos, G., van der Giessen, W. J., de Feyter, P. J., Wuelfert, E., Popma, J. J., Serruys, P. W. (2004). Intravascular ultrasound evaluation after sirolimus eluting stent implantation for de novo and in-stent restenosis lesions. Eur Heart J 25: 32-38 [Abstract] [Full Text]  
• Tanabe, K., Serruys, P. W., Grube, E., Smits, P. C., Selbach, G., van der Giessen, W. J., Staberock, M., de Feyter, P., Muller, R., Regar, E., Degertekin, M., Ligthart, J. M.R., Disco, C., Backx, B., Russell, M. E. (2003). TAXUS III Trial: In-Stent Restenosis Treated With Stent-Based Delivery of Paclitaxel Incorporated in a Slow-Release Polymer Formulation. Circulation 107: 559-564 [Abstract] [Full Text]  
• Serruys, P.W., Sianos, G., van der Giessen, W., Bonnier, H.J.R.M., Urban, P., Wijns, W., Benit, E., Vandormael, M., Dorr, R., Disco, C., Debbas, N., Silber, S. (2002). Intracoronary {beta}-radiation to reduce restenosis after balloon angioplasty and stenting. The Beta Radiation In Europe (BRIE) study. Eur Heart J 23: 1351-1359 [Abstract] [Full Text]  
• Serruys, P. W., Degertekin, M., Tanabe, K., Abizaid, A., Sousa, J. E., Colombo, A., Guagliumi, G., Wijns, W., Lindeboom, W. K., Ligthart, J., de Feyter, P. J., Morice, M.-C., for the RAVEL Study Group, (2002). Intravascular Ultrasound Findings in the Multicenter, Randomized, Double-Blind RAVEL (RAndomized study with the sirolimus-eluting VElocity balloon-expandable stent in the treatment of patients with de novo native coronary artery Lesions) Trial. Circulation 106: 798-803 [Abstract] [Full Text]  
• Regar, E., Kozuma, K., Sianos, G., Coen, V.L.M.A., van der Giessen, W.J., Foley, D., de Feyter, P., Rensing, B., Smits, P., Vos, J., Knook, A.H.M., Wardeh, A.J., Levendag, P.C., Serruys, P.W. (2002). Routine intracoronary beta-irradiation. Acute and one year outcome in patients at high risk for recurrence of stenosis. Eur Heart J 23: 1038-1044 [Abstract] [Full Text]  
• Mintz, G. S., Weissman, N. J., Fitzgerald, P. J. (2001). Intravascular Ultrasound Assessment of the Mechanisms and Results of Brachytherapy. Circulation 104: 1320-1325 [Full Text]