title: Late acute thrombotic occlusion after endovascular brachytherapy and stenting of femoropopliteal arteries.
abstract: OBJECTIVE
  The aim of this article is to underline the importance of this complication after endovascular brachytherapy (EVBT) and intravascular stenting of the femoropopliteal arteries occurring in a running randomized trial.
  
  
  BACKGROUND
  Endovascular brachytherapy has been proposed as a promising treatment modality to reduce restenosis after angioplasty. However, the phenomenon of late acute thrombotic occlusion (LATO) in patients receiving EVBT after stenting is of major concern.
  
  
  METHODS
  In an ongoing prospective multicenter trial, patients were randomized to undergo EVBT (iridium 192; 14 Gy at a depth of the radius of the vessel +2 mm) after percutaneous recanalization of femoropopliteal obstructions. Of the 204 patients who completed the six months follow-up, 94 were randomized to EVBT.
  
  
  RESULTS
  Late acute thrombotic occlusion occurred exclusively in 6 of 22 patients (27%) receiving EVBT after intravascular stenting and always in concomitance with reduction of antithrombotic drug prevention (clopidogrel). Conversely, none of the 13 patients with stents and without EVBT (0%; p < 0.05) and none of the 72 patients (0%; p < 0.01) undergoing EVBT after simple balloon angioplasty presented LATO.
  
  
  CONCLUSIONS
  Late thrombotic occlusion occurs not only in patients undergoing EVBT after percutaneous coronary recanalization but also after stenting of the femoropopliteal arteries and may compromise the benefits of endovascular radiation. The fact that all our cases with LATO occurred concomitantly with stopping clopidogrel may indicate a possible rebound mechanism. An intensive and prolonged antithrombotic prevention is probably indicated in these patients.
authors.affiliation: Division of Vascular Medicine, Ospedale San Giovanni (EOC), 6900 Bellinzona, Switzerland.
authors.forename: Robert
authors.initials: R
authors.lastname: Bonvini
authors.forename: Iris
authors.initials: I
authors.lastname: Baumgartner
authors.forename: Do Dai
authors.initials: DD
authors.lastname: Do
authors.forename: Mario
authors.initials: M
authors.lastname: Alerci
authors.forename: Jeanne-Marie
authors.initials: JM
authors.lastname: Segatto
authors.forename: Paolo
authors.initials: P
authors.lastname: Tutta
authors.forename: Kurt
authors.initials: K
authors.lastname: Jäger
authors.forename: Markus
authors.initials: M
authors.lastname: Aschwanden
authors.forename: Ernst
authors.initials: E
authors.lastname: Schneider
authors.forename: Beatrice
authors.initials: B
authors.lastname: Amann-Vesti
authors.forename: Richard
authors.initials: R
authors.lastname: Greiner
authors.forename: Felix
authors.initials: F
authors.lastname: Mahler
authors.forename: Augusto
authors.initials: A
authors.lastname: Gallino
mesh_terms: D000208:Acute Disease; D001157:Arterial Occlusive Diseases / Q000209:etiology*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D001918:Brachytherapy / Q000009:adverse effects*; D005263:Femoral Artery / Q000528:radiation effects* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000532:radiotherapy* / Q000601:surgery*; D011150:Popliteal Artery / Q000528:radiation effects* / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000209:etiology*; D013997:Time Factors