Intracoronary beta-radiation therapy inhibits recurrence of in-stent restenosis.
BACKGROUND
Intracoronary gamma-radiation therapy reduces recurrent in-stent restenosis (ISR). This study, BETA WRIST (Washington Radiation for In-Stent restenosis Trial) was designed to examine the efficacy and safety of the beta-emitter 90-yttrium for the prevention of recurrent ISR.


RESULTS
A total of 50 consecutive patients with ISR in native coronaries underwent percutaneous transluminal coronary angioplasty, laser angioplasty, rotational atherectomy, and/or stent implantation. Afterward, a segmented balloon catheter was positioned and automatically loaded with a 90-yttrium, 0.014-inch source wire that was 29 mm in length to deliver a dose of 20.6 Gy at 1.0 mm from the balloon surface. In 17 patients, manual stepping of the radiation catheter was necessary for lesions >25 mm in length. The radiation was delivered successfully to all patients, with a mean dwell time of 3.0+/-0.4 minutes. Fractionation of the dose due to ischemia was required in 11 patients. At 6 months, the binary angiographic restenosis rate was 22%, the target lesion revascularization rate was 26%, and the target vessel revascularization rate was 34%; all rates were significantly lower than those of the placebo group of gamma-WRIST.


CONCLUSIONS
beta-Radiation with a 90-yttrium source used as adjunct therapy for patients with ISR results in a lower-than-expected rate of angiographic and clinical restenosis.
Waksman
R
R
Vascular Brachytherapy Institute, Washington Hospital Center, Washington, DC 20010, USA. rxw8@mhg.edu
Bhargava
B
B
White
L
L
Chan
R C
RC
Mehran
R
R
Lansky
A J
AJ
Mintz
G S
GS
Satler
L F
LF
Pichard
A D
AD
Leon
M B
MB
Kent
K K
KK
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001610:Beta Particles; D001918:Brachytherapy; D003251:Constriction, Pathologic; D003327:Coronary Disease / Q000473:pathology / Q000532:radiotherapy*; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D015607:Stents; D017539:Tunica Intima / Q000473:pathology; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
D015021:Yttrium Radioisotopes