Treatment of bifurcation in-stent restenotic lesions with beta radiation using strontium 90 and sequential positioning pullback technique: procedural details and clinical outcomes.
BACKGROUND
In-stent restenotic lesions have been problematic for many patients with 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 bifurcation presents even more of a challenge. The use of radiation therapy for the treatment of this kind of lesion has not yet been reported. The purpose of this paper is to present five cases of radiation therapy in bifurcation in-stent restenotic lesions using the intraluminal beta radiation catheter delivery system (Beta-Cath  System, Novoste Corporation, Norcross, Georgia).


METHODS
We reviewed the database of patients enrolled in our Compassionate Use Registry between August 1999 and April 2002. The data is reported for 5 patients who received radiation in both branches of bifurcation lesions with the Beta-Cath  catheter system.


RESULTS
The mean diameter of the vessels was 3.1 mm   0.5 mm. The dose administered was from 18.3 to 23 Gy, with an overlap of 3.3 to 10.3 mm; the hinge angle between the branches went from 43.3 to 65.4 . Angiographic follow-up was obtained at 6 months in 4 patients, with a single patient showing a focal (< 5 mm) edge lesion treated by balloon angioplasty (TVR no TLR). No aneurysms or zones of ectasia were noted.


CONCLUSIONS
Beta radiation with the Beta-Cath  catheter system appears to be safe, secure and clinically useful in in-stent restenotic bifurcation lesions.
Costa
Ricardo
R
Institut de Cardiologie de Montreal, 5000 Belanger Street, Montreal, QC H1T 1C8, Canada. raoul.bonan@mmic.net
Joyal
Michel
M
Harel
Francois
F
Fox
Tim
T
Crocker
Ian
I
Arsenault
Andre
A
Gregoire
Jean
J
Bonan
Raoul
R
D000800:Angioplasty, Balloon / Q000379:methods; D001610:Beta Particles / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods*; D002170:Canada; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007496:Iridium Radioisotopes / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011874:Radiometry; D015607:Stents; D013326:Strontium Radioisotopes / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D007496:Iridium Radioisotopes; D013326:Strontium Radioisotopes