Feasibility of Intracoronary β-Irradiation to Reduce Restenosis After Balloon Angioplasty A Clinical Pilot Study

Background With the aim of decreasing the incidence of restenosis after coronary balloon angioplasty, we developed a technique of intracoronary β-irradiation using an endoluminally centered pure metallic 90Y source. The purpose of the present study was to evaluate the clinical feasibility and safety profile of this approach with a dose of 18 Gy delivered to the inner arterial surface. Methods and Results Between June 21 and November 15, 1995, fifteen patients (6 women and 9 men; mean age, 71±5 years) underwent intracoronary β-irradiation immediately after a conventional percutaneous transluminal coronary angioplasty (PTCA) procedure. The PTCA/irradiation procedure was technically feasible in all attempted cases, and the delivery of the 18 Gy dose was accomplished without complications. In 4 patients, the intervention was completed through intra-arterial stent implantation because of dissection induced by the initial PTCA. During the follow-up period of 178±17 days (range, 150 to 225 days), no complication...

[1]  W. Rutishauser,et al.  Intra-arterial beta irradiation prevents neointimal hyperplasia in a hypercholesterolemic rabbit restenosis model. , 1995, Circulation.

[2]  M. Nobuyoshi,et al.  Restenosis after successful percutaneous transluminal coronary angioplasty: serial angiographic follow-up of 229 patients. , 1988, Journal of the American College of Cardiology.

[3]  H. Amols,et al.  Intracoronary irradiation markedly reduces restenosis after balloon angioplasty in a porcine model. , 1994, Journal of the American College of Cardiology.

[4]  M. Harrison,et al.  773-5 Percutaneous Translumlnal Coronary Angioplasty (PTCA) and Intracoronary Radiation Therapy (ICRT): A Possible New Modality for the Treatment of Coronary Restenosis: A Preliminary Report of the First 10 Patients Treated with Intracoronary Radiation Therapy , 1995 .

[5]  H. Withers,et al.  Assay of radiation effects in mouse skin as expressed in wound healing. , 1988, Radiation research.

[6]  Lippincott Williams Wilkins,et al.  Does the new angiotensin converting enzyme inhibitor cilazapril prevent restenosis after percutaneous transluminal coronary angioplasty? Results of the MERCATOR study: a multicenter, randomized, double-blind placebo-controlled trial. Multicenter European Research Trial with Cilazapril after Angiopla , 1992, Circulation.

[7]  K. Bailey,et al.  Effect of external beam irradiation on neointimal hyperplasia after experimental coronary artery injury. , 1992, Journal of the American College of Cardiology.

[8]  A Zalewski,et al.  Adventitial remodeling after coronary arterial injury. , 1996, Circulation.

[9]  P. Teirstein,et al.  A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. , 1994, The New England journal of medicine.

[10]  J Weinberger,et al.  Intracoronary irradiation markedly reduces neointimal proliferation after balloon angioplasty in swine: persistent benefit at 6-month follow-up. , 1995, Journal of the American College of Cardiology.

[11]  H. Withers,et al.  The effect of local and systemic irradiation on impairment of wound healing in mice. , 1993, Radiation research.

[12]  K. Robinson,et al.  Intracoronary low-dose beta-irradiation inhibits neointima formation after coronary artery balloon injury in the swine restenosis model. , 1995, Circulation.

[13]  W. Rutishauser,et al.  Intra-arterial 90Y brachytherapy: preliminary dosimetric study using a specially modified angioplasty balloon. , 1995, International journal of radiation oncology, biology, physics.

[14]  B. Powers,et al.  Aortic wall injury following intraoperative irradiation. , 1988, International journal of radiation oncology, biology, physics.

[15]  P. Serruys,et al.  Does the New Angiotensin Converting Enzyme Inhibitor Cilazapril Prevent Restenosis After Percutaneous Transluminal Coronary Angioplast?: Results of the MERCATOR Study A Multicenter, Randomized, Double‐Blind Placebo‐Controlled Trial , 1992 .

[16]  K. Fox,et al.  Lack of effect of warfarin on the restenosis rate or on clinical outcome after balloon coronary angioplasty. , 1988, British heart journal.

[17]  D. Liermann,et al.  Endovascular irradiation--a new method to avoid recurrent stenosis after stent implantation in peripheral arteries: technique and preliminary results. , 1994, International journal of radiation oncology, biology, physics.

[18]  J. R. Stewart,et al.  Radiation injury to the heart. , 1995, International journal of radiation oncology, biology, physics.

[19]  R. Kerber,et al.  High frequency epicardial echocardiography for coronary artery evaluation: in vitro and in vivo validation of arterial lumen and wall thickness measurements. , 1986, Journal of the American College of Cardiology.

[20]  W. Rutishauser,et al.  High dose rate brachytherapy for prevention of restenosis after percutaneous transluminal coronary angioplasty: preliminary dosimetric tests of a new source presentation. , 1995, International journal of radiation oncology, biology, physics.

[21]  P. Schweitzer,et al.  Radiation therapy-induced cardiac injury. , 1995, American heart journal.

[22]  W Rutsch,et al.  A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. , 1994, The New England journal of medicine.

[23]  E. Falk,et al.  Remodeling rather than neointimal formation explains luminal narrowing after deep vessel wall injury: insights from a porcine coronary (re)stenosis model. , 1996, Circulation.

[24]  M. Friedman,et al.  The Antiatherogenic Effect of Iridium192 upon the Cholesterolfed Rabbit , 1964 .

[25]  W Siegenthaler,et al.  Long-term follow-up after percutaneous transluminal coronary angioplasty. The early Zurich experience. , 1987, The New England journal of medicine.

[26]  S. M. Collins,et al.  Variable morphology of coronary atherosclerosis: characterization of atherosclerotic plaque and residual arterial lumen size and shape by epicardial echocardiography. , 1992, Journal of the American College of Cardiology.

[27]  R Waksman,et al.  Endovascular low-dose irradiation inhibits neointima formation after coronary artery balloon injury in swine. A possible role for radiation therapy in restenosis prevention. , 1995, Circulation.

[28]  S. Withrow,et al.  Response of aorta and branch arteries to experimental intraoperative irradiation. , 1989, International journal of radiation oncology, biology, physics.