Treatment of long, diffuse, in-stent restenotic lesions with beta radiation using strontium 90 and sequential positioning "pullback" technique: procedural details and clinical outcomes.
BACKGROUND
Long, diffuse, in-stent restenotic lesions have been problematic for many patients, necessitating the need for multiple repeat percutaneous coronary interventions (PCI). The need for repeat PCI has been significantly reduced in patients since the advent of vascular brachytherapy. In-stent restenosis resulting in long lesions (> 30 mm) presents even more of a challenge. The interventional injury length created during PCI is usually greater than 30 mm and the vascular brachytherapy systems available in most hospitals are 30 mm or 40 mm in length. The purpose of this paper is to define "pullback technique" and to report the Montreal Heart Institute (MHI) data to show that the pullback technique using the Novoste system seems to be a safe and effective method for using vascular brachytherapy to treat long, diffuse, in-stent restenotic lesions.


METHODS
We reviewed the database of patients enrolled in the Compassionate Use Registry between August 1999 and July 2000. The data are reported on 23 consecutive patients treated with the pullback technique.


RESULTS
The mean lesion length was 49.4 +/- 19.8 mm. Three patients (13%) underwent target vessel revascularization. Angiographic follow-up was obtained in 18 patients (78%). Seven patients (38.8%) showed angiographic restenosis (> 50% luminal re-narrowing). No aneurysms or zones of ectasia were noted.


CONCLUSIONS
This angiographic and clinical evaluation of the MHI Compassionate Use Registry data show the pullback technique to be safe from both a dosimetric and clinical point of view.
Crocker
I
I
Montreal Heart Institute, 5000 East Belanger Street, Montreal (Quebec), Canada, H1T 1C8.
Joyal
M
M
Fox
T
T
Arsenault
A
A
Bonan
R
R
D001610:Beta Particles / Q000627:therapeutic use*; D002404:Catheterization; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000532:radiotherapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011878:Radiotherapy / Q000295:instrumentation*; D015607:Stents; D013324:Strontium / Q000627:therapeutic use*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D013324:Strontium