[Secondary effects of brachytherapy in the treatment of coronary restenosis].
Brachytherapy is proposed for the treatment or prevention of coronary restenosis with encouraging results, especially in intra-stent restenosis. The results of the first clinical studies show benefit, for example those of the American SCRIPPS trial with a 3 year follow-up. However, recent reports in the literature have described secondary effects associated with this technique: 1) stenoses occurring at the limits of the irradiated segments which are attributed to a proliferative effect of low doses on damaged tissue; 2) late occlusions at the irradiated site: their incidence is estimated at 9% at 6 months. The mechanisms of these thromboses are not understood but delayed re-endothelialisation probably plays a rôle; 3) finally, irradiation is associated with uncovered dissection probably related to delayed healing. Other long-term trials are necessary to provide a more complete assessment of the secondary effects of brachytherapy, especially with regards to their mechanisms, prevention and treatment.
Cottin
Y
Y
Service de Cardiologie Clinique et Interventionnelle, hôpital du Bocage, CHU Dijon, bd de-Lattre-de-Tassigny, 21034 Dijon.
Zeller
M
M
Allouch
P
P
Maingon
P
P
Barillot
I
I
Busseuil
D
D
Naudy
S
S
Horiot
J C
JC
Rochette
L
L
Wolf
J E
JE
D017130:Angioplasty; D001918:Brachytherapy / Q000009:adverse effects*; D003327:Coronary Disease / Q000532:radiotherapy* / Q000601:surgery; D003328:Coronary Thrombosis / Q000209:etiology; D006801:Humans; D006984:Hypertrophy; D012008:Recurrence; D015607:Stents; D016896:Treatment Outcome; D014945:Wound Healing