Beta radiation in lesions > 15 mm: a START subgroup.
BACKGROUND
Following conventional treatment of in-stent restenosis, clinical restenosis may be as high as 60% in long lesions. Results of the START (Stents and Radiation Therapy) trial indicate that intracoronary beta radiation yields significant reductions in the incidence of recurrent in-stent restenosis as compared with placebo.


RESULTS
In a subgroup of the START trial, results in patients with coronary lesions > 15 mm in length (n = 239) were analyzed to assess treatment with a 30 mm, beta radiation source train. Patients received an intracoronary catheter with (90)Strontium/(90)Yttrium (n = 128) or placebo (n = 111). Clinical and angiographic parameters were evaluated at 8 months. Patient demographics and angiographic lesion characteristics were similar between the 2 groups. The mean lesion lengths were comparable in the radiation and placebo groups (21.5 5.2 mm versus 22.1 5.5 mm, respectively; p = 0.3873). A total of 14.1% and 22.5% of patients in the radiation and placebo groups, respectively, received new stents (p = 0.09). At 8 months, radiation therapy yielded significant reductions in major adverse cardiac events (16.4% versus 29.7%; p = 0.014), target vessel revascularization (14.8% versus 28.8%; p = 0.0085) and target lesion revascularization (11.7% versus 27.9%; p = 0.0015). There was no stent thrombosis, and binary restenosis rates were significantly lower in the radiation group compared to placebo.


CONCLUSIONS
Intracoronary beta radiation may prevent early recurrent restenosis in long lesions. Additional study is required to determine if the reduction persists throughout mid- to long-term follow-up.
Heuser
Richard
R
Cardiovascular Research, St Joseph's Hospital and Medical Center/Phoenix Heart Center, Phoenix, AZ 85006, USA. phoenixheart@earthlink.net
Laskey
Warren
W
Lansky
Alexandra
A
Popma
Jeffrey
J
Bonan
Raoul
R
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001610:Beta Particles / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods*; D023903:Coronary Restenosis / Q000209:etiology / Q000517:prevention & control / Q000532:radiotherapy* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000009:adverse effects*; D055502:Secondary Prevention; D015607:Stents / Q000009:adverse effects*