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European Heart Journal 2000 21(24):2063-2070; doi:10.1053/euhj.2000.2465
Copyright © 2000 by the European Society of Cardiology.
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Relationship between tensile stress and plaque growth after balloon angioplasty treated with and without intracoronary beta-brachytherapy

K Kozumaa, M.A Costaa, M Sabatéa, C.J Slagera, E Boersmaa, I.P Kaya, J.P.A Marijnissenb, S.G Carliera, J.J Wentzela, A Thurya, J.M.R Ligtharta, V.L.M.A Coenb, P.C Levendagb and P.W Serruysa,f1

a Department of Interventional Cardiology, Thoraxcenter, University Hospital Dijkzigt Rotterdam and Erasmus University, The Netherlands
b Daniel den Hoed Cancer Center, Rotterdam, The Netherlands

revised September 11, 2000; accepted September 18, 2000

Abstract

Aims We investigated the influence of tensile stress on plaque growth after balloon angioplasty with and without beta-radiation therapy.

Methods and Results Thirty-one consecutive patients successfully treated with balloon angioplasty were analysed qualitatively and quantitatively by means of an ECG-gated three-dimensional intravascular ultrasound post-procedure and at follow-up. Eighteen patients were irradiated with catheter-based beta-radiation (90Sr/90Y source) and 13 were not (control). Studied segments were divided into 2mm subsegments. Thus 184 irradiated and 111 non-irradiated subsegments were included. Tensile stress was calculated according to Laplace's law. The radiation dose was calculated by means of dose–volume histograms. Plaque growth was positively correlated to tensile stress in both the radiation and control groups (r=0·374,P =0·0001 and r=0·305, P=0·001). Low-dose subsegments (<6Gy) had a significant correlation (r=0·410, P=0·0001) whereas no correlation was observed in the effective-dose subsegments (≥6Gy). Multivariate analysis identified tensile stress as the only independent predictor of plaque increase in non-irradiated subsegments, whereas actual dose and plaque morphology were stronger predictors in irradiated subsegments.

Conclusion The results of this study suggest that plaque growth is related to tensile stress after balloon angioplasty. Intracoronary brachytherapy may alter the biophysical process on plaque growth when the prescribed dose is effectively delivered.

Key Words: Tensile stress, balloon angioplasty, intracoronary radiation, intravascular ultrasound, plaque growth, dose–volume histogram

f1 Correspondence: Prof. P. W. Serruys, MD, PhD, Department of Interventional Cardiology, University Hospital Rotterdam Dijkzigt, Thoraxcenter Bd418, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.

References

  1. Teirstein PS, Massullo V, Jani S. Catheter-based radiotherapy to inhibit restenosis after coronary stenting. N Engl J Med. 1997;336:1697–1703[Abstract/Free Full Text]
  2. King SB 3rd, Williams DO, Chougule P. Endovascular beta-radiation to reduce restenosis after coronary balloon angioplasty: results of the beta energy restenosis trial (BERT). Circulation. 1998;97:2025–2030[Abstract/Free Full Text]
  3. Verin V, Urban P, Popowski Y. Feasibility of intracoronary beta-irradiation to reduce restenosis after balloon angioplasty. A clinical pilot study. Circulation. 1997;95:1138–1144[Abstract/Free Full Text]
  4. Condado JA, Waksman R, Gurdiel O. Long-term angiographic and clinical outcome after percutaneous transluminal coronary angioplasty and intracoronary radiation therapy in humans. Circulation. 1997;96:727–732[Abstract/Free Full Text]
  5. Waksman R, Rodriguez JC, Robinson KA. Effect of intravascular irradiation on cell proliferation, apoptosis, and vascular remodeling after balloon overstretch injury of porcine coronary arteries. Circulation. 1997;96:1944–1952[Abstract/Free Full Text]
  6. Meerkin D, Tardif JC, Crocker IR. Effects of intracoronary beta-radiation therapy after coronary angioplasty: an intravascular ultrasound study. Circulation. 1999;99:1660–1665[Abstract/Free Full Text]
  7. Wiedermann JG, Marboe C, Amols H, Schwartz A, Weinberger J. Intracoronary irradiation markedly reduces neointimal proliferation after balloon angioplasty in swine: persistent benefit at 6-month follow-up. J Am Coll Cardiol. 1995;25:1451–1456[Abstract]
  8. Sabate M, Serruys PW, van der Giessen WJ. Geometric vascular remodeling after balloon angioplasty and beta-radiation therapy: A three-dimensional intravascular ultrasound study. Circulation. 1999;100:1182–1188[Abstract/Free Full Text]
  9. Sabaté M, Marijnissen JPA, Carlier SG. Residual plaque burden, delivered dose and tissue composition predict the 6-month outcome after balloon angioplasty and ß-radiation therapy. Circulation. 2000;101:2472–2477[Abstract/Free Full Text]
  10. Osol G. Mechanotransduction by vascular smooth muscle. J Vasc Res. 1995;32:275–292[Web of Science][Medline]
  11. Wilson E, Sudhir K, Ives HE. Mechanical strain of rat vascular smooth muscle cells is sensed by specific extracellular matrix/integrin interactions. J Clin Invest. 1995;96:2364–2372[Web of Science][Medline]
  12. Glagov S. Intimal hyperplasia, vascular modeling, and the restenosis problem. Circulation. 1994;89:2888–2891[Free Full Text]
  13. Langille BL. Remodeling of developing and mature arteries: endothelium, smooth muscle, and matrix. J Cardiovasc Pharmacol. 1993;21:S11–17
  14. Krams R, Wentzel JJ, Oomen JA. Evaluation of endothelial shear stress and 3D geometry as factors determining the development of atherosclerosis and remodeling in human coronary arteries in vivo. Combining 3D reconstruction from angiography and IVUS (ANGUS) with computational fluid dynamics. Arterioscler Thromb Vasc Biol. 1997;17:2061–2065[Abstract/Free Full Text]
  15. Mazur W, Ali MN, Khan MM. High dose rate intracoronary radiation for inhibition of neointimal formation in the stented and balloon-injured porcine models of restenosis: angiographic, morphometric, and histopathologic analyses. Int J Radiat Oncol Biol Phys. 1996;36:777–788[CrossRef][Web of Science][Medline]
  16. Waksman R, Robinson KA, Crocker IR, Gravanis MB, Cipolla GD, King SB 3rd. Endovascular low-dose irradiation inhibits neointima formation after coronary artery balloon injury in swine. A possible role for radiation therapy in restenosis prevention. Circulation. 1995;91:1533–1539[Abstract/Free Full Text]
  17. Bruining N, von Birgelen C, de Feyter PJ, Ligthart J, Serruys PW, Roelandt JR. Dynamic imaging of coronary stent structures: an ECG-gated three-dimensional intracoronary ultrasound study in humans. Ultrasound Med Biol. 1998;24:631–637[CrossRef][Web of Science][Medline]
  18. Bruining N, von Birgelen C, de Feyter PJ. ECG-gated versus nongated three-dimensional intracoronary ultrasound analysis: implications for volumetric measurements. Cathet Cardiovasc Diagn. 1998;43:254–260[CrossRef][Web of Science][Medline]
  19. von Birgelen C, de Vrey EA, Mintz GS. ECG-gated three-dimensional intravascular ultrasound: feasibility and reproducibility of the automated analysis of coronary lumen and atherosclerotic plaque dimensions in humans. Circulation. 1997;96:2944–2952[Abstract/Free Full Text]
  20. Li W, von Birgelen C, Di Mario C. Semi-automated contour detection for volumetric quantification of intracoronary ultrasound. Comput Cardiol. 1994;:277–280
  21. Bruining N, Sabate M, de Feyter PJ. Quantitative measurements of in-stent restenosis: A comparison between quantitative coronary ultrasound and quantitative coronary angiography. Catheter Cardiovasc Interv. 1999;48:133–142[CrossRef][Web of Science][Medline]
  22. Costa MA, Sabate M, Serrano P. The effect of P32 beta-radiotherapy on both vessel remodeling and neointimal hyperplasia after coronary balloon angioplasty and stenting. A three-dimensional intravascular ultrasound investigation. J Invas Cardiol. 2000;12:113–120[Web of Science][Medline]
  23. Sabate M, Costa MA, Kozuma K. Geographic miss: A cause of treatment failure in radio-oncology applied to intracoronary radiation therapy. Circulation. 2000;101:2467–2471[Abstract/Free Full Text]
  24. Arbab-Zadeh A, DeMaria AN, Penny WF, Russo RJ, Kimura BJ, Bhargava V. Axial movement of the intravascular ultrasound probe during the cardiac cycle: implications for three-dimensional reconstruction and measurements of coronary dimensions. Am Heart J. 1999;138:865–872[CrossRef][Web of Science][Medline]
  25. Di Mario C, Gorge G, Peters R. Clinical application and image interpretation in intracoronary ultrasound. Study Group on Intracoronary Imaging of the Working Group of Coronary Circulation and of the Subgroup on Intravascular Ultrasound of the Working Group of Echocardiography of the European Society of Cardiology. Eur Heart J. 1998;19:207–229[Free Full Text]
  26. Clarijs JA, Pasterkamp G, Schoneveld AH, van Leeuwen TG, Hillen B, Borst C. Compensatory enlargement in coronary and femoral arteries is related to neither the extent of plaque-free vessel wall nor lesion eccentricity. A postmortem study. Arterioscler Thromb Vasc Biol. 1997;17:2617–2621[Abstract/Free Full Text]
  27. Masawa N, Glagov S, Zarins CK. Quantitative morphologic study of intimal thickening at the human carotid bifurcation: I. Axial and circumferential distribution of maximum intimal thickening in asymptomatic, uncomplicated plaques. Atherosclerosis. 1994;107:137–146[CrossRef][Web of Science][Medline]
  28. Drzymala RE, Mohan R, Brewster L. Dose-volume histograms. Int J Radiat Oncol Biol Phys. 1991;21:71–78[Web of Science][Medline]
  29. Carlier SG, Marijnissen JP, Coen VL. Guidance of intracoronary radiation therapy based on dose–volume histograms derived from quantitative intravascular ultrasound. IEEE Trans Med Imaging. 1998;17:772–778[CrossRef][Web of Science][Medline]
  30. Teirstein PS, Massullo V, Jani S. A subgroup analysis of the Scripps Coronary Radiation to Inhibit Proliferation Poststenting Trial. Int J Radiat Oncol Biol Phys. 1998;42:1097–1104[CrossRef][Web of Science][Medline]
  31. Kamiya A, Togawa T. Adaptive regulation of wall shear stress to flow change in the canine carotid artery. Am J Physiol. 1980;239:H14–21
  32. Deng LY, Schiffrin EL. Effects of endothelin-1 and vasopressin on resistance arteries of spontaneously hypertensive rats. Am J Hypertens. 1992;5:817–822[Web of Science][Medline]
  33. Glagov S, Vito R, Giddens DP, Zarins CK. Micro-architecture and composition of artery walls: relationship to location, diameter and the distribution of mechanical stress. J Hypertens. 1992;10:S101–104
  34. Birukov KG, Shirinsky VP, Stepanova OV. Stretch affects phenotype and proliferation of vascular smooth muscle cells. Mol Cell Biochem. 1995;144:131–139[CrossRef][Web of Science][Medline]
  35. Lee RT, Schoen FJ, Loree HM, Lark MW, Libby P. Circumferential stress and matrix metalloproteinase 1 in human coronary atherosclerosis. Implications for plaque rupture. Arterioscler Thromb Vasc Biol. 1996;16:1070–1073[Abstract/Free Full Text]
  36. McMillan WD, Tamarina NA, Cipollone M, Johnson DA, Parker MA, Pearce WH. Size matters: the relationship between MMP-9 expression and aortic diameter. Circulation. 1997;96:2228–2232[Abstract/Free Full Text]
  37. Wilcox JN, Waksman R, King SB, Scott NA. The role of the adventitia in the arterial response to angioplasty: the effect of intravascular radiation. Int J Radiat Oncol Biol Phys. 1996;36:789–796[CrossRef][Web of Science][Medline]
  38. Di Mario C, The SH, Madretsma S. Detection and characterization of vascular lesions by intravascular ultrasound: an in vitro study correlated with histology. J Am Soc Echocardiogr. 1992;5:135–146[Medline]
  39. von Birgelen C, van der Lugt A, Nicosia A. Computerized assessment of coronary lumen and atherosclerotic plaque dimensions in three-dimensional intravascular ultrasound correlated with histomorphometry. Am J Cardiol. 1996;78:1202–1209[CrossRef][Web of Science][Medline]
  40. Sabate M, Kay IP, de Feyter PJ. Remodeling of atherosclerotic coronary arteries varies in relation to location and composition of plaque. Am J Cardiol. 1999;84:135–140[CrossRef][Web of Science][Medline]
  41. Schwartz RS, Koval TM, Edwards WD. Effect of external beam irradiation on neointimal hyperplasia after experimental coronary artery injury. J Am Coll Cardiol. 1992;19:1106–1113[Abstract]
  42. Weinberger J, Amols H, Ennis RD, Schwartz A, Wiedermann JG, Marboe C. Intracoronary irradiation: dose response for the prevention of restenosis in swine. Int J Radiat Oncol Biol Phys. 1996;36:767–775[CrossRef][Web of Science][Medline]

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