Compassionate use of intracoronary beta-irradiation for treatment of recurrent in-stent restenosis.
Recurrent in-stent restenosis after balloon angioplasty poses a serious management problem. Previously g-radiation has been shown to be effective in patients with in-stent restenosis. The aim of the study was to determine the feasibility and safety of b-radiation in patients with recurrent in-stent restenosis. From May 1997 to December 1998, 18 patients were treated with balloon angioplasty (n = 8) or laser (n = 10), followed by intracoronary b-radiation at a prescribed dose of 16 Gray at 2 mm from the source, for reference diameters by quantitative coronary angiography < 3.25 mm or 20 Gray for reference diameters > or =3.25 mm. Vessels treated were as follows: left anterior descending: (n = 5); circumflex: (n = 4); right coronary artery: (n = 6); saphenous vein graft: (n = 3). Average recurrence rate was 2.4 +/- 0.7 and the restenotic length was 16 +/- 7 mm. b-radiation was successfully delivered in all patients. Two patients presented complications related to laser debulking: a non-Q wave myocardial infarction in one and a re-angioplasty due to uncovered distal dissection in another. Geographical miss, defined as an area which has been injured but not covered by the radiation source, was demonstrated in 8 patients. Seventeen patients (94%) completed the 6-month angiographic follow-up. Restenosis (> 50% Diameter Stenosis) was observed in 9 patients (53%), leading to target lesion revascularization in 8 patients (47%). Six of the 9 restenoses were located in areas with geographical miss. Intracoronary b-radiation for recurrent in-stent restenosis appears to be a safe and feasible management strategy. However, the mismatch between injured and irradiated area may lead to failure of this therapy.
Sabaté
M
M
Department of Interventional Cardiology, Thoraxcenter Bd 418, University Hospital Dijkzigt, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Kay
I P
IP
Gijzel
A L
AL
Wardeh
A J
AJ
Van der Giessen
W J
WJ
Coen
V L
VL
Ligthart
J M
JM
Costa
M A
MA
Kozuma
K
K
Serrano
P
P
Levendag
P C
PC
Serruys
P W
PW
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D001610:Beta Particles / Q000627:therapeutic use; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D001918:Brachytherapy / Q000379:methods*; D023903:Coronary Restenosis / Q000209:etiology / Q000532:radiotherapy* / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D018714:Radiotherapy, Adjuvant / Q000379:methods; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome