Late acute thrombotic occlusion after endovascular brachytherapy and stenting of femoropopliteal arteries.
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.
Bonvini
Robert
R
Division of Vascular Medicine, Ospedale San Giovanni (EOC), 6900 Bellinzona, Switzerland.
Baumgartner
Iris
I
Do
Do Dai
DD
Alerci
Mario
M
Segatto
Jeanne-Marie
JM
Tutta
Paolo
P
Jäger
Kurt
K
Aschwanden
Markus
M
Schneider
Ernst
E
Amann-Vesti
Beatrice
B
Greiner
Richard
R
Mahler
Felix
F
Gallino
Augusto
A
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