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(Circulation. 2002;106:539.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Two-Year Angiographic Follow-Up of Intracoronary Sr90 Therapy for Restenosis Prevention After Balloon Angioplasty

David Meerkin, MBBS; Michel Joyal, MD; Jean-Claude Tardif, MD; Jacques Lespérance, MD; André Arsenault, MD; Guylaine Lucier, RN; Raoul Bonan, MD

From the Montreal Heart Institute (D.M., M.J., J.-C.T., J.L., A.A., G.L., R.B.), Montreal, Canada; and the Shaare Zedek Medical Center (D.M.), Jerusalem, Israel.

Correspondence to Raoul Bonan, MD, Montreal Heart Institute Research Center, 5000 Belanger Street East, Montreal, Quebec, H1T 1C8, Canada. E-mail raoul.bonan{at}mmic.net

Background— Postcoronary angioplasty vascular brachytherapy (VBT) has emerged as a successful intervention for restenosis prevention in some clinical scenarios. Longer-term follow-up after VBT in de novo nonstented lesions has not been reported.

Methods and Results— Thirty patients treated with post–percutaneous transluminal coronary angioplasty (PTCA) VBT with Sr⁹⁰ underwent clinical and angiographic follow-up at 6 and 24 months. Specific vessel segment quantitative coronary angiographic analyses were performed to identify radiation edge effects. Nineteen patients who had not undergone index procedure stenting or target vessel revascularization (TVR) over the 2-year period were analyzed separately. Of the 30 patients, 3 underwent TVR by 6-month follow-up. An additional 4 patients required TVR between 6 and 24 months. In the total cohort of 26 patients undergoing angiographic follow-up at 6 and 24 months, an increase in minimal lumen diameter of the initial target segment was noted at 6 months compared with postprocedure analysis (2.31±0.48 versus 2.04±0.43 mm, P<0.05). At 24 months, this was no longer significant (2.19±0.61 mm). In the proximal segments of the entire cohort and the nonintervened subgroup, the principal late loss occurred over the first 6 months with no additional late loss at 2-year follow-up. The distal segments remained stable over the entire follow-up period.

Conclusions— Although some late failures of post-PTCA VBT are seen between 6 and 24 months, most treated vessels remain stable with no late loss or additional luminal increase beyond the 6-month period. This suggests that late aneurysm formation and significant late edge restenosis are unlikely in VBT after PTCA of de novo lesions for up to 2 years.

Key Words: radioisotopes • restenosis • angioplasty • angiography

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