Beta-radiation for coronary in-stent restenosis

Stent; Vascular disease; Coronary heart disease; Cardiovascular disease; Arterial disease; Radiotherapy; Instrumentation therapy; Prognosis; Recurrence; Prevention; Treatment efficiency; Beta irradiation; Treatment; Human; Coronary artery; Restenosis; Complication; Endoprosthesis; Vaisseau sanguin pathologie; Cardiopathie coronaire; Radiothérapie; Artère pathologie; Appareil circulatoire pathologie; Récurrence; Pronostic; Traitement instrumental; Irradiation bêta; Efficacité traitement; Prévention; Artère coronaire; Homme; Traitement; Resténose; Endoprothèse

Abstract :

[en] To determine the feasibility and safety of an intracoronary beta-radiation device in preventing the recurrence of in-stent restenosis (ISR) after successful angioplasty, we studied 37 patients treated with beta-radiation (30-mm strontium-90 source) after angioplasty. The mean reference diameter was 2.9 ± 0.5 mm, and 62% of lesions were diffuse, including four total occlusions. Beta-radiation was successfully delivered in 36 of 37 (97%) cases. Over the course of 7.1 ± 4.5 mo follow-up, there were no myocardial infarctions and three deaths: one from preexisting malignancy, one from progressive cardiac failure, and one from sudden cardiac death. Target vessel revascularization (TVR) was performed in seven of 36 (19%) patients. Thirty patients underwent angiography at 6 mo; three (10%) experienced restenosis (diameter stenosis > 50%) at the target site, four (13%) had edge stenoses, and two (7%) had late (> 1 mo) thrombotic occlusions. Beta-radiation for ISR is associated with encouragingly low rates of target lesion restenosis and TVR. Further improvements are needed to solve the limitations of the edge effect and late occlusion.

Disciplines :

Oncology

Author, co-author :

Latchem, D-R

Urban, P

Goy, JJ

De Benedetti, E

COUCKE, Philippe ; Centre Hospitalier Universitaire Vaudois

Pica, A

Eeckhout, E

Language :

English

Title :

Beta-radiation for coronary in-stent restenosis

Publication date :

2000

Journal title :

Catheterization and Cardiovascular Interventions

ISSN :

1522-1946

eISSN :

1522-726X

Publisher :

Wiley Liss, New York, United States - New York

Volume :

Issue :

Pages :

422-429

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 18 February 2010

Statistics

Number of views

47 (0 by ULiège)

Number of downloads

168 (0 by ULiège)

More statistics

Scopus citations^®

Scopus citations^®
without self-citations

OpenCitations

Bibliography

Gruentzig A.R., King III S.B., Schlumpf M., Siegenthaler W. (1987) Longterm follow-up after percutaneous transluminal coronary angioplasty: The early Zurich experience. N Engl J Med 316:1127-1132.
Holmes D.R., Vliestra R.E., Smith H.C. (1984) Restenosis after percutaneous transluminal coronary angioplasty (PTCA): A report from the PTCA registry of the National Heart, Lung and Blood Institute. Am J Cardiol 53.
Fischman D.L., Leon M.B., Baim D.S., Schatz R.A., Savage M.P., Penn I., Detre K., Veltri L., Ricci D., Nobuyosh M., Cleman M., Heuser R., Almond D., Teirstein P.S., Fish R.D., Colombo A., Brinker J., Moses J., Shaknovich A., Hirshfeld J., Bailey S., Ellis S., Rake R., Goldberg S. (1994) A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 331:496-501.
Serruys P.W., DeJaegere P., Kiemeneij F., Macaya C., Rutsch W., Heyndrickx G., Emanuelsson H., Marco J., Legrand V., Materne P., Belardi J., Sigwart U., Colombo A., Goy J.J., Van Den Heuvel P., Delcan J., Morel M. (1994) A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med 331:489-495.
Hoffmann R., Mintz G.S., Dussaillant G.R., Popma J.J., Pichard A.D., Satler L.F., Kent K.M., Griffin J., Leon M.B. (1996) Patterns and mechanisms of in-stent restenosis a serial intravascular ultrasound study. Circulation 94:1247-1254.
Bauters C., Banos J.-L., Van Belle E., Mc Fadden E.P., Lablanche J.-M., Bertrand M.E. (1998) Six-month angiographic outcome after successful repeat percutaneous intervention for in-stent restenosis. Circulation 97:318-321.
Reimers B., Moussa I., Akiyama T., Tucc G., Ferraro M., Martini G., Blengino S., Di Mario C., Colombo A. (1997) Long-term clinical follow-up after successful repeat percutaneous intervention for stent restenosis. J Am Coll Cardiol 30:186-192.
Satler L.F. (1996) Remedies for in-stent restenosis. Cathet Cardiovasc Diagn 37:320-321.
Elezi S., Kastrati A., Hadamitzky M., Dirschinger J., Neumann F.J., Schomig A. (1999) Clinical and angiographic follow-up after balloon angioplasty with provisional stenting for coronary in-stent restenosis. Cathet Cardiovasc Intervent 48:151-156.
Al-Serangi H.S., Ho P.C., Nesto R.W., Levis S.M., Leeman D., Fitzpatrick P., Mittleman M., Waxman S., Shubrooks S.J. (1999) Stenting for in-stent restenosis: A long-term clinical follow-up. Cathet Cardiovasc Intervent 48:143-148.
Stone G.W. (1996) Rotational atherectomy for treatment of in-stent restenosis: Role of intracoronary ultrasound guidance. Cathet Cardiovasc Diagn 37(SUPPL. 3):73-77.
Koster R., Hamm C., Terres W. (1997) Treatment of in-stent coronary restenosis by excimer laser angioplasty. Am J Cardiol 80:1424-1428.
Mehran R., Mintz G.S., Satler L.F., Pichard A.D., Kent K.M., Bucher T.A., Popma J.J., Leon M. (1997) Treatment of in-stent restenosis with excimer laser coronary angioplasty: Mechanisms and results compared with PTCA alone. Circulation 96:2183-2189.
Izumi M., Suzuki T., Matsubara T. (1998) Results of cutting balloon angioplasty for stent restenosis: Japanese multicenter registry. J Am Coll Cardiol 31.
Chevalier B., Royer T., Guyon P., Glatt B. (1999) Treatment of in-stent restenosis: Short and midterm results of a pilot randomised study between balloon and cutting balloon. J Am Coll Cardiol 33(2 SUPPL. A).
Baim D.S., Levine M.J., Leon M.B., Levine S., Ellis S.G., Schatz R.A. (1993) Management of restenosis within the Palmaz-Schatz coronary stent (the U.S. multicenter experience). Am J Cardiol 71:364-366.
Macander P.J., Roubin G.S., Agawal S.K. (1994) Balloon angioplasty for the treatment of in-stent restenosis: Feasibility, safety and efficacy. Cathet Cardiovasc Diagn 32:125-131.
Mehran R., Mintz G., Popma J., Pichard A.D., Satler L.F., Kent K.M., Griffin J., Leon M.B. (1996) Mechanisms and results of balloon angioplasty for the treatment of in-stent restenosis. Am J Cardiol 78:618-622.
Mintz G.S., Hoffman R., Mehran R., Pichard A.D., Kent K.M., Satler L.F., Popma J.J., Leon M.B. (1998) In-stent restenosis: The Washington Hospital Center experience. Am J Cardiol 81(7 A).
Mehran R., Dangas G., Abizad A.S., Mintz G.S., Lanksy A.J., Satler L.F., Pichard A.P., Kent K.M., Stone G.W., Leon M.B. (1999) Angiographic patterns of in-stent restenosis: Classification and implications for long-term outcome. Circulation 100:1872-1878.
Verin V., Popowski Y., Urban P., Belenger J., Redard M., Costa M., Widmer M.-C., Michel Rouzaud, Nouet P., Grob E., Schwager M., Kurtz J.M., Rutishauser W. (1995) Intra-arterial beta irradiation prevents neointimal hyperplasia in a hypercholesterolemic rabbit restenosis model. Circulation 92:2284-2290.
King III S.B., Williams D.O., Chougule P., Klein J.L., Waksman R., Hilstead R., Macdonald J., Anderberg K., Crocker I.R. (1998) Endovascular β-radiation to reduce restenosis after coronary balloon angioplasty: Results of the Beta Energy Restenosis Trial (BERT). Circulation 97:2025-2030.
Teirstein P.S., Massullo V., Jani S., Popma J.J., Mintz G.S., Russo R.J., Schatz R.A., Guarneri E.M., Steuterman S., Morris N.B., Leon M.B., Tripuraneni P. (1997) Catheter-based radiotherapy to inhibit restenosis after coronary stenting. N Engl J Med 336:1697-1703.
Waksman R., White L.R., Chan R.C., Bass W.G., Geirlach L.M., Mintz G.S., Satler L.F., Mehran R., Serruys P.W., Lanksy A.J., Fitzgerald P., Bhargava B., Kent K.M., Pichard A.D., Leon M.B. (2000) Intracoronary γ-radiation therapy after angioplasty inhibits recurrence in patients with in-stent restenosis. Circulation 101:2165-2171.
Leon M.B., Moses J.W., Lanksy A.J., Wong S.C., Nawaz D.M., Whitlow P.L., Fish D.R., Kluck B., Gorgianni J., Kuntz R.E., Teirstein P.S. (1999) Intracoronary gamma radiation for the prevention of recurrent in-stent restenosis: Final results from the Gamma I trial. Circulation 100:1-75.
Bonan R., Meerkin D., Bertrand O. (1999) Geographic miss: What is it?. J Invas Cardiol 11:749-756.
Popma J.J., Heuser R., Suntharalingam M., Teirstein P.S., Massullo V., Bass T., Henderson R., Silber S., Von Rottkay P., Lansky A.J., Bonan R., Kuntz R.E. (2000) Late clinical and angiographic outcomes after use of beta radiation for the treatment of in-stent restenosis: Results from the stents and radiation therapy (START) trial. Forty-ninth Annual Scientific Sessions of the American College of Cardiology, March; .
Sabate M., Kay I.P., Gijzel A.L., Wardeh A.J., Van der Giessen, Coen V.L.M.A., Ligthart J.M.R., Costa M.A., Kozuma K., Serrano P., Levendag P., Serruys P. (1999) Compassionate use of intracoronary betairradiation for treatment of recurrent in-stent restenosis. J Invas Cardiol 11:582-588.
Albiero R., Adamian M., Kobayashi N., Amato A., Vaghetti M., Di Mario C., Colombo A. (2000) Short- and intermediate-term results of 32P radioactive β-emitting stent implantation in patients with coronary artery disease: The Milan dose-response study. Circulation 101:18-26.
Costa M.A., Sabate M., Van der Giessen W.J., Kay I.P., Cervinka P., Ligthart J.M.R., Serrano P., Coen V.L.M.A., Levendag P.C., Serruys P.W. (1999) Late coronary occlusion after intracoronary brachytherapy. Circulation 100:789-792.
Waksman R. (1999) Late thrombosis after radiation: Sitting on a time bomb. Circulation 100:780-782.
Hehrlein C., Stintz M., Kinscherf R., Schlosser K., Huttel E., Friedrich L., Fehsenfeld P., Kubler W. (1996) Pure beta-particle-emitting stents inhibit neointima formation in rabbits. Circulation 93:641-645.
Carter A.J., Laird J.R., Bailey L.R., Hoopes T.G., Farb A., Fischell D.R., Fischell R.E., Fischell T.A., Virmani R. (1996) Effects of endovascular radiation from a β-particle-emitting stent in a porcine coronary restenosis model: A dose-response study. Circulation 94:2364-2368.
Elezi S., Kastrati A., Pache J., Wehinger A., Hadamitzky M., Dirschinger J., Neumann F.-J., Schomig A. (1998) Diabetes mellitus and the clinical and angiographic outcome after coronary stent placement. J Am Coll Cardiol 32(7):1866-1873.
Williams D.O. (1998) Radiation vascular therapy: A novel approach to preventing restenosis. Am J Cardiol 81(7 A).