Intracoronary radiation to treat in-stent restenosis in six cardiac transplant patients.
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.
Grise
Mark A
MA
Division of Cardiovascular Disease, Scripps Clinic, La Jolla, California 92037, USA.
Reilly
John P
JP
Tobis
Jonathan M
JM
Takano
Yuzuru
Y
Currier
Jesse W
JW
Kobashigawa
Jon A
JA
Weisz
Giora
G
Moses
Jeffrey W
JW
Leon
Martin B
MB
Yeung
Alan
A
Teirstein
Paul S
PS
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
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin; D000077284:Abciximab