Baylacher, Monika

Dühmke, Eckart

Kantlehner, Ralf

Klauss, Volker

Krötz, Florian

König, Andreas

Pöllinger, Barbara

Rieber, Johannes

Schiele, Thomas M.

Sohn, Hae-Young

Theisen, Karl

Zimmermann, Andrea

Elsevier - Publisher Connector 

JACC March 6, 2002 
0 to 44%). Conclusion: Early lumen area loss occurred frequently at 9t minutes after 
treatment of diffuse ISR. These data may suggest that early lumen loss may be one of 
the important mechanisms of recurrence of ISR in diffuse ISR. 
ABSTRACTS - ACCIS2002 (Angiography & Interventional Cardiology) 35A 
response after conventional catheter-basod treatment of SVG ISR lesions. This biologi- 
cal difference may explain higher recurrence rates after treatment of SVG ISR lesions 
Ref diameter, mm 2.60±0.47 2.77±0.40 0.01 2.71±0.32 NS 
MLD, mm 0.78±0.33 2.23±0.39 <0.0001 2.06±0.67 NS 
Lumen CSA, mm2 2.0±0.9 6.4±1.3 <0.0001 4.5±0.8 <0.0001 
EEM CSA£, mm2 17.9±3.8 18.2±3.9 NS 18.4±4.0 NS 
Stent CSA, mm2 8.9±2.4 9.3±2.4 NS 9.2±2.3 NS 
Plaque CSA, mm2 15.9±3.3 11.8±3.2 0.02 13 .9±3.9  0.0001 
1103-12 Direct Stenting Improves Target Lesion 
Revascularization in Saphenous Vein Graft Lesions: An 
Intravascular Ultrasound-Guided Study 
Andrea S. Abizaid. Roxana Mehran, Gary S. Mintz, Alaxandra J. Lansky, Gregg W. 
Stone, Alexandre Abizaid, George Dangas, Thos Limpijankit, Yanis lakovou, Jeffrey 
Moses, Martin B. Leon, Lenox Hill Heart & Vascular institute, New York, Cardiovascular 
Research Foundation, New York. 
Background: Direct stenting (DS) may be associated with lower acute and long-term 
complications especially in saphenous vein graft lesions (SVG) that are prone to both 
acute complications (distal embolization, slow/no-reflow) and late recurrence. 
Methods: We analyzed 786 patients who underwent intravascular ultrasound (IVUS)- 
guided stent implantation i  SVG lesions: 75 pts with DS and 711 with pre-dilation plus 
stenting (B+S). Pts were followed for one year. Acute procedural results and long-term 
follow-up are reported (Table). Results: Pts treated with DS were older (71±8 vs 68±9 
years, p=0.01); had lower ejection fractions (35±11% vs 42±15%, p=O.O02); and more 
degenerated SVG lesions (45% vs 28%, p=0.0001) compared to pts treated with 
B+S.Conclusions: Despite having more degenerated isease, pts treated with IVUS- 
guided DS of SVG lesions had (1) larger lumen dimensions, (2) fewer angiographic om- 
plications, (3) a reduction in non-Q myocardial infarctions (reduced frequency of CK-MB 
elevation), and lower rates of TLR compared to pts treated with a strategy of B+S. Thus, 
IVUS-guided DS may be the preferred method of treating these high-risk Iflsions. 
DS B+S p 
Angiographic omplications, % (dissections, distal 
embolization, or slow/no reflow 
# of stents 
CK-MB elevation(_>5x normal),% 
Final IVUS lumen area, mm 2 
Final IVUS minimum stent area, mm 2 
Final IVUS minimum lumer diameter(ram) 
1-year target Iseion revascularization, %
2.3 8.9 0.001 
2.0±1.2 1.9±1.2 NS 
15 26 0.07 
8.71±2.75 8.11±2.47 0.004 
9.02±2.42 8.31±2.44 0.01 
3.2±0.4 2.9±0.5 0.001 
6.4 16.1 0.03 
POSTER SESS ION 
1104 Intravascular Ultrasound and 
Mechanisms of Disease 
Monday, March 18, 2002, Noon-2:00 p.m. 
Georgia World Congress Center, Hall G 
Presentation Hour: Noon-l:00 pm 
1104-13 Serial (Postintervention and Follow-Up) Volumetric 
Intravascular Ultrasound Findings in Recurrent In-Stent 
Restenosis Lesions: A Comparison of Native Coronary 
Artery and Saphenous Vein Grafts After Conventional 
Catheter-Based Treatment 
Javed M. Ahmed, Gary S, Mintz., Marco T. Castagna, Marco Zimarino, Ron Waksman, 
Augusto D. Pichard, Lowell F. Satler, Kenneth M. Kent, Nell J. Weissman. 
We compared serial (post-intervention a d follow-up) volumetric intravascular ultrasound 
(IVUS) findings after conventional catheter-based treatment of recurrent in-stent resteno- 
sis (ISR) lesions in native coronary arteries and saphenous vein grafts (SVG). Patients 
were selected from the placebo arms of two randomized intracoronary 7-radiation trials 
WRIST (Washington Radiation For In-Stent Restanosis Trial)and SVG WRIST. IVUS 
measurements included mean stent, lumen, inUmal hyperptasia (IH=stent-lumen) cross- 
sectional areas (CSA); minimum lumen CSA (MLA); and maximum (Max) IH CSA 
Results. Native ISR lesions were slightly longer. Mean post-intervention stent and IH 
CSA were similar in native and SVG ISR lesions. However, post-intervention mean and 
minimum lumen CSA's were significantly larger in SVG WRIST lesions (Table). At follow- 
up there was a more heterogeneous response in IH distribution over the length of SVG 
ISR lesions resulting in a greater increase in maximum IH CSA and a greater decrease in 
follow-up minimum lumen CSA in SVG lesions. 
Conclusion, Serial IVUS analysis shows that there is a more heterogeneous neointimal 
without adjunct vascular brachytherapy. 
Native ISR (n=39) SVG ISR (n=36) P 
Length (mm) 29±11.0 25±10.8 0.08 
Post-intervention 
Mean stent CSA (mm2) 9.1±2.5 10.1±3.2 0.13 
Mean lumen CSA (mm2) 5.8±2.4 7.3±2.3 0.007 
Mean IH CSA (mm2) 2.7±1.8 3.2±1.7 0.19 
Max IH CSA (mm2) 3.8±1.7 4.6±2.4 0.12 
MLA (mm2) 4.8±1.4 5.6±1.6 0.02 
Follow-up 
Max IH CSA (mm2) 5.3±1.5 8.2±3.2 <0.0001 
MLA (mm2) 3.0±1.3 2.8±1.3 0.53 
8 
Max IH CSA (mm2) 1.4±1.3 4.4±2.1 <0.0001 
MLA (mm2) -1.7±1.3 -2.8±1.7 0.004 
1104-14 Angiographic and Intravascular Ultrasound Analysis of 
Overlapped Beta-Radiation Fields on Vessel Geometry 
After Manual Stepping Brachytherapy 
Thomas M. Schiela. Andraas K6nig, Andrea Zimmermann, Johannes Rieber, Florian 
KrStz, Hae-Young Sohn, Monika Baylacher, Barbara PSflinger, Ralf Kantlehner, Eckart 
D0hmke, Karl Theisen, Volker Klauss, University Hospital, Ludwig-Maximilians- 
Universi~ Munich, German Z 
Background: Intracoronary radiation has been shown to be effective for the treatment of 
in-stent restenosis. Longer lesions exceed available radiation length requiring manual 
stepping for complete coverage of the injured vessel segment. We investigated the 
effects of overlapped radiation fields on the vessel geometry. 
Methods: Serial angiogrephic and intravascular ultrasound analysis was performed in 17 
patients. Following interventional procedures, a non-cantered 90Sr/90Y seed train of 
40ram length was used for brachytherapy. The radiation catheter was positioned in 2 
steps. Exact positioning avoiding gaps or overlaps was attempted. Serial (post radiation 
and foUow-up) quantitative coronary angiography measurements ofminimal lumen diam- 
eter (MLD) and late lumen loss (LLL) and volumetric intravascular ultrasound measure- 
ments (automated motorized pullback, speed 0.5mm/sec) of the lumen cross sectional 
area (CSA) (LA), stent CSA (SA), total vessel CSA (VA), neointima CSA (NIA) and paris- 
tent CSA (PSA) were performed at overlapped and adjacent sites. 
Results: Mean lesion length was 52.5±17.2mm. Reference diameter measured 
3.0±0.5mm. Radiotherapy was successful in all patients. Complete match of overlapped 
radiation fields was achieved in 1 patient, geographic miss occured in 1 patient (-O.6mm) 
and overlap in 15 patients (range 0.6 to 4.6mm), At 9 months, there was no evidence of 
perforation or aneurysm at the overlapped segments. Angiographic and IVUS results are 
shown in the table, 
Parameter Overlapped segment Adjacent segment p value 
MLD post intervention [mm] 2.87±0.69 2.78_+0.69 0.456 
MLD follow-up [mm] 2.65i~0.65 2.44_+0.74 0.387 
LLL [ram] 0.22+0.31 0.34±0.27 0.552 
Change mean SA [mm 2] -0.28+0.45 -0.22±0.43 0.981 
Change mean LA [mm =] -0.57±1.2 -0.93±1.1 0.355 
Change mean NIA [mm ~] +0.29-]:1.1 +0.71+1.3 0.245 
Change mean VA [ram 2] -0.42-+0.88 +0.49_+0.71 0.001 
Change mean PSA [mm 2] -1.37+1.22 +0.71±0.82 0.011 
1104-15 Variability of Area Measurements Obtained With 
Different Intravascular Ultrasound Catheter Systems: 
Impact on Clinical Trials and a Method for Accurate 
Calibration 
Paul Schoenhaoen. Timothy D. Crowe, William A. Magyar, Shelly Sapp, Jennifer 
Popovich, Geoffrey D. Vinca, Steven E. Nissen, Murat E. Tuzcu, The Cleveland Clinic 
Foundation, Cave/and, Ohio. 
Background: Intravascular ultrasound allows precise and highly reproducible measure- 
ments of coronary artery dimensions. Atherosclerotic plaque burden is the major end- 
point in ongoing progression trials. The variability of cross-sectional area (CSA) 
measurements between different catheter systems is incompletely characterized. 
Methods: Intravascular ultrasound imaging was performed using a cylindrical phantom 
with 5 sections of different known CSA ranging from 3.24 to 27.99 ram2. A total of 3642 
in-vitro measurements with 4 different catheter systems (Atlantis TM, Ultra-Cross TM, In- 
Vision TM, Avenar TM) were performed. These measurements were divided tnto a model 
building and a validation dataset. Models containing up to a 8th order term were evalu- 
ated. The adjusted R2, the prediction sum of squares (PRESS) and the mean square 
prediction error (MSPR) were used in the model selection process. 
Results; Over- and under- estimation of the true CSA of up to 18% was observed with 
different catheter systems. Calibration equations for the different systems could be devel- 
Before After P* 91 minlater P~ 


Angiographic and intravascular ultrasound analysis of overlapped beta-radiation fields on vessel geometry after manual stepping brachytherapy 

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Angiographic and intravascular ultrasound analysis of overlapped beta-radiation fields on vessel geometry after manual stepping brachytherapy

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