(Circulation. 2000;101:1895.)
© 2000 American Heart Association, Inc.
Brief Rapid Communication |
Intracoronary ß-Radiation Therapy Inhibits Recurrence of In-Stent Restenosis
From the Vascular Brachytherapy Institute, Washington Hospital Center, Washington, DC.
Background—Intracoronary
-radiation therapy reduces recurrent in-stent restenosis
(ISR). This study, BETA WRIST (Washington Radiation for In-Stent
restenosis Trial) was designed to examine the efficacy and
safety of the ß-emitter 90-yttrium for the prevention of
recurrent ISR.
Methods and Results—A total of 50 consecutive patients with ISR
in native coronaries underwent percutaneous
transluminal coronary angioplasty, laser angioplasty,
rotational atherectomy, and/or stent implantation. Afterward, a
segmented balloon catheter was positioned and automatically loaded with
a 90-yttrium, 0.014-inch source wire that was 29 mm in length to
deliver a dose of 20.6 Gy at 1.0 mm from the balloon surface. In
17 patients, manual stepping of the radiation catheter was necessary
for lesions >25 mm in length. The radiation was delivered
successfully to all patients, with a mean dwell time of 3.0±0.4
minutes. Fractionation of the dose due to ischemia was required
in 11 patients. At 6 months, the binary angiographic restenosis
rate was 22%, the target lesion revascularization
rate was 26%, and the target vessel
revascularization rate was 34%; all rates were
significantly lower than those of the placebo group of -WRIST.
Conclusions—ß-Radiation with a 90-yttrium source used as adjunct therapy for patients with ISR results in a lower-than-expected rate of angiographic and clinical restenosis.
Key Words: stents • restenosis • beta rays • brachytherapy
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