[Radioactive stents: problems and potential solutions].
BACKGROUND
The implantation of radioactive stents was the first procedure of a coronary brachytherapy in Europe examined in multicenter clinical trials.
After more than 400 patients with radioactive stents were analyzed, it became clear that overall restenosis rates were not reduced. A new phenomenon called the "edge effect" or "candy-wrapper" effect was discovered, which later was also described for catheter-based brachytherapy. Currently, the implantation of radioactive stents for the prevention of restenosis cannot be recommended.
Although technical improvements of radioactive stents are theoretically possible, novel drug coated stents may overcome any future research of stent-based radiotherapy. Drug eluting stents induce antiproliferative effects beyond the stent margins. Edge effects were not observed in preliminary trials. However, long-term results need to be awaited.
Hehrlein
Christoph
C
Abteilung für Kardiologie und Angiologie, Medizinische Universitätsklinik III, Freiburg/Br. hehrlein@med1.ukl.uni-freiburg.de
D015906:Angioplasty, Balloon, Coronary; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D001918:Brachytherapy; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D010761:Phosphorus Radioisotopes / Q000008:administration & dosage*; D010865:Pilot Projects; D016032:Randomized Controlled Trials as Topic; D020123:Sirolimus / Q000008:administration & dosage; D013193:Stainless Steel; D015607:Stents
D000903:Antibiotics, Antineoplastic; D007166:Immunosuppressive Agents; D010761:Phosphorus Radioisotopes; D013193:Stainless Steel; D020123:Sirolimus