Document Detail


Vascular changes and black hole phenomenon after coronary brachytherapy: a pathologically distinct entity.
MedLine Citation:
PMID:  18830004     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Restenosis remains an important issue even after coronary brachytherapy despite its efficacy in the treatment for in-stent restenosis. The acute and chronic changes in vascular wall are unique following brachytherapy. The restenotic tissue post coronary brachytherapy is relatively acellular and appears echolucent in intravascular ultrasound examination. This is dubbed the "black hole" phenomenon. Despite the similarity in the mode of action of brachytherapy and drug eluting stent implantation, the black hole phenomenon seems to be uncommon after drug-eluting stent implantation except in those patients who have had prior brachytherapy, bare-metal placement and after treatment of saphenous venous graft stenosis. It is possible that not all neointima in stents are created equal. We should propose that neointima be considered primary neointima if it forms after bare metal stenting, secondary neointima if it forms after CBT or DES, and perhaps tertiary if after combined CBT and DES. This type of classification may prove useful for research or clinical purposes. Almost certainly black hole phenomenon results from a modified neointima. However, we do not know whether this is the same restenotic tissue that was present before CBT but just depleted of its cellular element secondary to autolysis or a newly formed tertiary neointima? It is also not clear whether the changes in vascular wall and restenosis are similar after CBT or drug-eluting stent placement. However, there are some unique vascular changes that seem to be common after both of these procedures.
Authors:
Santhosh K G Koshy; Neal S Kleiman; Lekha K George; Vijay Misra; William B Hillegass; Brigitta C Brott
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  20     ISSN:  1557-2501     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-02     Completed Date:  2009-03-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  560-2     Citation Subset:  IM    
Affiliation:
Department of Medicine, University of Tennessee Health Science Center, 1211 Union Avenue, Suite 340, Memphis, TN 38104, USA. skoshy@utmem.edu
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MeSH Terms
Descriptor/Qualifier:
Brachytherapy / adverse effects*
Coronary Restenosis / physiopathology,  prevention & control*,  radiotherapy,  ultrasonography
Coronary Vessels / pathology*,  radiation effects,  ultrasonography
Drug-Eluting Stents*
Humans

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