[Clinical and angiographic one-year follow-up of vascular beta-brachytherapy for coronary lesions treated by a stent with a very high risk for restenosis].
BACKGROUND
Vascular brachytherapy (VBT) has been proven to reduce restenosis rate and unwanted cardiac events in several randomized trials. Long-term data on populations at high risk for re-interventions are few. The aim of this study was to assess the acute and one-year outcome of beta-radiation in coronary in-stent restenoses with a high likelihood of recurrence.


METHODS
In 79 patients, VBT using 90Yttrium/Strontium or 32Phosphorus, was performed. Clinical and angiographic follow-up was carried out after 6 months and 1 year.


RESULTS
44.4 % of patients had three-vessel coronary artery disease and a high prevalence of cardiovascular risk factors and comorbidity. Mean lesion length was 36.8+/-18.9 mm. VBT was successful in all patients. Fractionation of VBT was necessary in 2,5 %. Acute gain of luminal diameter was 2.15+/-0.89 mm. During the hospital stay one acute myocardial infarction (AMI) not associated with VBT occurred. After 6 months loss of luminal diameter measured 0.39+/-0.47 mm, equaling a restenosis rate (RR) of 16.8 % (1 year: 0.60+/-0.56 mm, RR 33.5 %). 18.9 % of patients required revascularization of the target lesion (1 year: 29.5 %). After 6 months, all patients survived, three had an AMI after discontinuation of clopidogrel, one of them was asymptomatic (1 year: 1 cardiac death, 2 symptomatic AMI).


CONCLUSIONS
Beta-VBT in patients at a high risk for recurrence after angioplasty is feasible and safe. Though the clinical and angiographic results at 1 year showed some impairment as opposed to the 6-months-follow-up, they nevertheless are largely superior to those patients from historic controls not treated with VBT.
Kardiologie, Medizinische Klinik, Klinikum der Universität München-Innestadt, Munich. Thomas.Schiele@medinn.med.uni-muenchen.de
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TM
Schiele
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Pöllinger
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Kantlehner
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Dühmke
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K
Theisen
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Klauss
D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D015897:Comorbidity; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000453:epidemiology / Q000517:prevention & control / Q000532:radiotherapy*; D023921:Coronary Stenosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D055502:Secondary Prevention; D015607:Stents; D016896:Treatment Outcome