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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.


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P.W. Serruys and S.G. Carlier
Brachytherapy in the Journal: European cardiologists have their own forum and should use it!
Eur. Heart J., December 2, 2000; 21(24): 1994 - 1996.
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