title: Intracoronary radiation to treat in-stent restenosis in six cardiac transplant patients.
abstract: Transplant vasculopathy significantly limits the survival of cardiac transplant patients and occurs in 50% of patients by 5 years posttransplant. We report our experience with six cardiac transplant patients who underwent intracoronary brachytherapy for in-stent restenosis. At four centers, six patients underwent intracoronary radiation for in-stent restenosis. All patients received extended antiplatelet therapy with clopidogrel and aspirin. Follow-up angiography was performed in all patients. Two of the six patients underwent subsequent target lesion revascularization. Patient 1 presented with total occlusion of her radiated lesion. She had a complex procedure requiring stenting for a dissection after the radiation dwell. Patient 2 had high-grade restenosis following brachytherapy. Patient 3 had a 50% restenotic lesion. Patients 4, 5, and 6 had follow-up angiography that showed no evidence of restenosis. There are few good options to treated accelerated transplant vasculopathy. Radiation therapy may be a viable option in this difficult patient population.
authors.affiliation: Division of Cardiovascular Disease, Scripps Clinic, La Jolla, California 92037, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Grise
authors.forename: John P
authors.initials: JP
authors.lastname: Reilly
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Tobis
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Takano
authors.forename: Jesse W
authors.initials: JW
authors.lastname: Currier
authors.forename: Jon A
authors.initials: JA
authors.lastname: Kobashigawa
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Alan
authors.initials: A
authors.lastname: Yeung
authors.forename: Paul S
authors.initials: PS
authors.lastname: Teirstein
mesh_terms: D000077284:Abciximab; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001158:Arteries / Q000473:pathology / Q000528:radiation effects / Q000601:surgery; D001241:Aspirin / Q000627:therapeutic use; D019917:Blood Vessel Prosthesis Implantation; D001918:Brachytherapy; D002140:California; D000077144:Clopidogrel; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000175:diagnosis / Q000532:radiotherapy / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology / Q000528:radiation effects / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012086:Reoperation; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin; D000077284:Abciximab