192IR endovascular brachytherapy for avoidance of intimal hyperplasia after percutaneous transluminal angioplasty and stent implantation in peripheral vessels: 6 years of experience.
OBJECTIVE
Percutaneous transluminal angioplasty (PTA) with or without stent implantation is the accepted standard in the therapy of occlusive arterial disease. Despite improvements in the technique and medical equipment, there is still a restenosis rate of up to 40%. A high-dose-rate afterloading technique to avoid vascular stenosis or occlusion after PTA and subsequent stent implantation caused by intimal hyperplasia is presented with long-term results.


METHODS
Intravascular brachytherapy with a 10-Ci 192Ir source was performed in cases of recurrent vascular occlusion or stenosis which appeared within 6 months after a previous PTA. After recanalization by PTA and stent implantation, a 9-Fr ReKa catheter was positioned within the stent to center the applicator with its tip 2 cm below the stent. This catheter served as a guide for a 5-Fr flexible applicator. After this procedure the isodose was calculated and a 12-Gy to 3-mm source distance was applied. The procedure was followed by 72 h of heparinization.


RESULTS
From May 1990 to June 1996, 28 patients (21 male and seven female) were treated with endovascular brachytherapy. All patients had a clinically relevant restenosis or reocclusion of the arteria femoralis. Follow-up time ranged from 1 to 71 months. Twenty-eight patients had a sufficient follow-up time; 25 of these patients were examined. Twenty-one patients had treated vessel segments; four patients had no flow in the treated area. Two patients moved away with unknown addresses, and one patient died without any follow-up examination. Radiation-associated side effects were not notable.


CONCLUSIONS
Intraluminal brachytherapy with 192Ir is a safe and useful procedure to avoid endovascular hyperplasia after transluminal percutaneous angioplasty.
Schopohl
B
B
Department of Radiation Oncology, J.W. Goethe University Hospital, Frankfurt, Germany.
Leirmann
D
D
Pohlit
L J
LJ
Heyd
R
R
Strassmann
G
G
Bauersachs
R
R
Schulte-Huermann
D
D
Rahl
C G
CG
Manegold
K H
KH
Kollath
J
J
Bottcher
H D
HD
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000517:prevention & control / Q000532:radiotherapy* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005263:Femoral Artery / Q000473:pathology / Q000528:radiation effects*; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia / Q000517:prevention & control; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000517:prevention & control / Q000532:radiotherapy / Q000628:therapy; D011879:Radiotherapy Dosage; D012008:Recurrence; D015607:Stents; D017539:Tunica Intima / Q000473:pathology / Q000528:radiation effects
D007496:Iridium Radioisotopes