Endovascular brachytherapy for prophylaxis against restenosis after long-segment femoropopliteal placement of stents: initial results.
OBJECTIVE
To evaluate the feasibility, safety, and effectiveness of endovascular brachytherapy for the prevention of restenosis after long-segment femoropopliteal percutaneous transluminal angioplasty (PTA) and stent implantation.


METHODS
Thirty-three patients (23 men, 10 women; mean age, 66 years) with femoropopliteal lesions (mean treated length, 17 cm; range, 4-30 cm) underwent PTA and stent implantation followed by brachytherapy with a centering catheter. A dose of 14 Gy was delivered to the adventitia by using an iridium 192 source. Long-term pharmacotherapy with acetylsalicylic acid was combined with clopidogrel for 1 month. Follow-up examinations included measurement of the ankle-brachial index, color-coded duplex ultrasonography, and angiography.


RESULTS
The overall 6-month recurrence rate was 30% (10 of 33 arteries). Seven patients developed sudden late thrombotic occlusion of the segment with the stent 3.5-6 months after stent implantation. Considering the overall results after successful local thrombolysis in six of these seven patients, only four (12%) of 33 arteries with a stent had in-stent restenosis caused by neointimal hyperplasia.


CONCLUSIONS
The study results are promising concerning the possibility of reducing in-stent restenosis by means of brachytherapy after long-segment femoropopliteal placement of stents. The high incidence of late thrombotic occlusion requires optimization of the antithrombotic regimen.
Wolfram
R M
RM
Department of Angiology, University of Vienna General Hospital, Währinger Gürtel 18-20, A-1097 Vienna, Austria.
Pokrajac
B
B
Ahmadi
R
R
Fellner
C
C
Gyöngyösi
M
M
Haumer
M
M
Bucek
R
R
Pötter
R
R
Minar
E
E
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001918:Brachytherapy / Q000379:methods*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery; D011183:Postoperative Complications / Q000517:prevention & control; D055502:Secondary Prevention; D015607:Stents; D014654:Vascular Patency