This Article Full Text Full Text (PDF) All Versions of this Article: 105/23/2737    most recent 01.CIR.0000018126.87045.E0v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Grise, M. A. Articles by Teirstein, P. S. Search for Related Content PubMed PubMed Citation Articles by Grise, M. A. Articles by Teirstein, P. S. Related Collections Restenosis Catheter-based coronary interventions: stents

(Circulation. 2002;105:2737.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Five-Year Clinical Follow-Up After Intracoronary Radiation

Results of a Randomized Clinical Trial

Mark A. Grise, MD; Vincent Massullo, MD; Shirish Jani, PhD; Jeffrey J. Popma, MD; Robert J. Russo, MD, PhD; Richard A. Schatz, MD; Erminia M. Guarneri, MD; Stephen Steuterman, MS; David A. Cloutier, BS; Martin B. Leon, MD; Prabhakar Tripuraneni, MD; Paul S. Teirstein, MD

From the Division of Cardiovascular Diseases (M.A.G., R.J.R., R.A.S., E.M.G., S.S., D.A.C., P.S.T.) and Division of Radiation Oncology (V.M., S.J., P.T.), Scripps Clinic, La Jolla, Calif; Division of Cardiology (J.J.P.), Brigham and Women’s Hospital, Boston, Mass; and Division of Cardiology (M.B.L.), Lenox Hill, New York, NY.

Correspondence to Paul S. Teirstein, MD, Division of Cardiovascular Diseases, Scripps Clinic, 10666 North Torrey Pines Rd, La Jolla, CA 92037. E-mail Radman{at}scrippsclinic.com

Background— Several clinical trials indicate that intracoronary radiation is safe and effective for treatment of restenotic coronary arteries. We previously reported 6-month and 3-year clinical and angiographic follow-up demonstrating significant decreases in target lesion revascularization (TLR) and angiographic restenosis after radiation of restenotic lesions. The objective of this study was to document the clinical outcome 5 years after treatment of restenotic coronary arteries with catheter-based iridium-192 (¹⁹²Ir).

Methods and Results— A double-blind, randomized trail compared ¹⁹²Ir to placebo sources in patients with restenosis after coronary angioplasty. Over a 9-month period, 55 patients were enrolled; 26 were randomized to ¹⁹²Ir and 29 to placebo. At 5-year follow-up, TLR was significantly lower in the ¹⁹²Ir group (23.1% versus 48.3%; P=0.05). There were 2 TLRs between years 3 and 5 in patients in the ¹⁹²Ir group and none in patients in the placebo group. The 5-year event-free survival rate (freedom from death, myocardial infarction, or TLR) was greater in ¹⁹²Ir-treated patients (61.5% versus 34.5%; P=0.02).

Conclusions— Despite apparent mitigation of efficacy over time, there remains a significant reduction in TLR at 5 years and an improvement in event-free survival in patients treated with intracoronary ¹⁹²Ir. The early clinical benefits after intracoronary radiation with ¹⁹²Ir seem durable at 5-year clinical follow-up.

Key Words: restenosis • angioplasty • stents • radioisotopes

This article has been cited by other articles:

				S. G. Ellis, C. D. O'Shaughnessy, S. L. Martin, K. Kent, T. McGarry, M. A. Turco, D. J. Kereiakes, J. J. Popma, M. Friedman, J. Koglin, et al. Two-year clinical outcomes after paclitaxel-eluting stent or brachytherapy treatment for bare metal stent restenosis: the TAXUS V ISR trial Eur. Heart J., July 1, 2008; 29(13): 1625 - 1634. [Abstract] [Full Text] [PDF]

				J. M. Wilson and J. T. Willerson Myocardial Revascularization with Percutaneous Devices Card. Surg. Adult, January 1, 2008; 3(2008): 573 - 598. [Full Text]

				X. Guo, K.-H. Chen, Y. Guo, H. Liao, J. Tang, and R.-P. Xiao Mitofusin 2 Triggers Vascular Smooth Muscle Cell Apoptosis via Mitochondrial Death Pathway Circ. Res., November 26, 2007; 101(11): 1113 - 1122. [Abstract] [Full Text] [PDF]

				J.-i. Kotani, M. Awata, S. Nanto, M. Uematsu, F. Oshima, H. Minamiguchi, G. S. Mintz, and S. Nagata Incomplete Neointimal Coverage of Sirolimus-Eluting Stents: Angioscopic Findings J. Am. Coll. Cardiol., May 16, 2006; 47(10): 2108 - 2111. [Abstract] [Full Text] [PDF]

				D. R. Holmes Jr, P. Teirstein, L. Satler, M. Sketch, J. O'Malley, J. J. Popma, R. E. Kuntz, P. J. Fitzgerald, H. Wang, E. Caramanica, et al. Sirolimus-Eluting Stents vs Vascular Brachytherapy for In-Stent Restenosis Within Bare-Metal Stents: The SISR Randomized Trial JAMA, March 15, 2006; 295(11): 1264 - 1273. [Abstract] [Full Text] [PDF]

				D. Mukherjee and D. J. Moliterno Brachytherapy for In-Stent Restenosis: A Distant Second Choice to Drug-Eluting Stent Placement JAMA, March 15, 2006; 295(11): 1307 - 1309. [Full Text] [PDF]

				J. Aoki, A. Colombo, D. Dudek, A. P. Banning, J. Drzewiecki, K. Zmudka, F. Schiele, M. E. Russell, J. Koglin, P. W. Serruys, et al. Peristent Remodeling and Neointimal Suppression 2 Years After Polymer-Based, Paclitaxel-Eluting Stent Implantation: Insights From Serial Intravascular Ultrasound Analysis in the TAXUS II Study Circulation, December 20, 2005; 112(25): 3876 - 3883. [Abstract] [Full Text] [PDF]

				K D Dawkins, T Gershlick, M de Belder, A Chauhan, G Venn, P Schofield, D Smith, J Watkins, H H Gray, and Joint Working Group on Percutaneous Coronary Inter Percutaneous coronary intervention: recommendations for good practice and training Heart, December 1, 2005; 91(suppl_6): vi1 - vi27. [Abstract] [Full Text] [PDF]

				G Sianos, A Hoye, F Saia, W van der Giessen, P Lemos, P J de Feyter, P C Levendag, R van Domburg, and P W Serruys Long term outcome after intracoronary {beta} radiation therapy Heart, July 1, 2005; 91(7): 942 - 947. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, S. Silber, P. Albertsson, F. F. Aviles, P. G. Camici, A. Colombo, C. Hamm, E. Jorgensen, J. Marco, J.-E. Nordrehaug, et al. Guidelines for Percutaneous Coronary Interventions: The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology Eur. Heart J., April 2, 2005; 26(8): 804 - 847. [Full Text] [PDF]

				K. Goshima and J. L. Mills Sr De Novo Femoropopliteal stenoses: Endovascular Gamma Irradiation Following Angioplasty-Angiographic and Clinical Follow-up in a Prospective Randomized Controlled Trial Perspectives in Vascular Surgery and Endovascular Therapy, March 1, 2005; 17(1): 69 - 70. [Abstract] [PDF]

				R. Waksman Vascular brachytherapy and coronary stenting for de novo lesions: Love on the rocks J. Am. Coll. Cardiol., August 4, 2004; 44(3): 538 - 540. [Full Text] [PDF]

				K. Krueger, M. Zaehringer, M. Bendel, H. Stuetzer, D. Strohe, M. Nolte, D. Wittig, R.-P. Mueller, and K. Lackner De Novo Femoropopliteal Stenoses: Endovascular Gamma Irradiation Following Angioplasty--Angiographic and Clinical Follow-up in a Prospective Randomized Controlled Trial Radiology, May 1, 2004; 231(2): 546 - 554. [Abstract] [Full Text] [PDF]

				P. S. Teirstein A Chicken in Every Pot and a Drug-Eluting Stent in Every Lesion Circulation, April 27, 2004; 109(16): 1906 - 1910. [Full Text] [PDF]

				V Bhatia, R Bhatia, and M Dhindsa Drug-eluting stents: new era and new concerns Postgrad. Med. J., January 1, 2004; 80(939): 13 - 18. [Abstract] [Full Text] [PDF]

				H.-J. Cho, H.-S. Kim, M.-M. Lee, D.-H. Kim, H.-J. Yang, J. Hur, K.-K. Hwang, S. Oh, Y.-J. Choi, I.-H. Chae, et al. Mobilized Endothelial Progenitor Cells by Granulocyte-Macrophage Colony-Stimulating Factor Accelerate Reendothelialization and Reduce Vascular Inflammation After Intravascular Radiation Circulation, December 9, 2003; 108(23): 2918 - 2925. [Abstract] [Full Text] [PDF]

				P. S. Teirstein and S. King Vascular Radiation in a Drug-Eluting Stent World: It's Not Over Till It's Over Circulation, July 29, 2003; 108(4): 384 - 385. [Full Text] [PDF]

				R. Waksman and J. Weinberger Coronary Brachytherapy in the Drug-Eluting Stent Era: Don't Bury It Alive Circulation, July 29, 2003; 108(4): 386 - 388. [Full Text] [PDF]

				R. Waksman, E. Cheneau, A. E. Ajani, R. L. White, E. Pinnow, R. Torguson, R. Deible, L. F. Satler, A. D. Pichard, K. M. Kent, et al. Intracoronary Radiation Therapy Improves the Clinical and Angiographic Outcomes of Diffuse In-Stent Restenotic Lesions: Results of the Washington Radiation for In-Stent Restenosis Trial for Long Lesions (Long WRIST) Studies Circulation, April 8, 2003; 107(13): 1744 - 1749. [Abstract] [Full Text] [PDF]

				R Seabra-Gomes In-stent restenosis: intracoronary {beta}-radiation at the crossroads Eur. Heart J., April 1, 2003; 24(7): 583 - 585. [Full Text] [PDF]

				D. E. Kandzari and D. B. Mark Intracoronary Brachytherapy: Time to Sell Short? Circulation, August 6, 2002; 106(6): 646 - 648. [Full Text] [PDF]

				D. O. Williams Intracoronary Brachytherapy: Past, Present, and Future Circulation, June 11, 2002; 105(23): 2699 - 2700. [Full Text] [PDF]