(Circulation. 1997;96:727-732.)
© 1997 American Heart Association, Inc.
Articles |
Long-term Angiographic and Clinical Outcome After Percutaneous Transluminal Coronary Angioplasty and Intracoronary Radiation Therapy in Humans
From the Department of Cardiology, Hospital Miguel Perez-Carrefio (J.A.C., O.G., R.E., J.G., B.B., G.V., H.A.), Centro Medico Caracas, Venezuela; Lake Charles, La (S.F.L.); and Department of Radiation Oncology (I.R.C.) and Andreas Gruentzig Cardiovascular Center (R.W., K.B.S.), Emory University Hospital, Atlanta, Ga.
Correspondence to Dr Ron Waksman, Cardiology Research Foundation, Washington Hospital Center, 100 Irving St NW, Suite 4B-1, Washington, DC 20010.
Background Ionizing radiation has been shown to reduce neointimal formation after balloon angioplasty in experimental models of restenosis. This study was designed to evaluate the feasibility, safety, and effectiveness of intracoronary radiation therapy (ICRT) after percutaneous transluminal coronary angioplasty (PTCA) for preventing restenosis in human coronary arteries.
Methods and Results Twenty-one patients (22 arteries) with
unstable angina underwent standard balloon angioplasty. ICRT was
performed with the use of an 192Ir source wire that was
hand delivered to the angioplasty site. Angiographic follow-up was
performed at 24 hours, between 30 and 60 days, and at 6 months.
Angioplasty was successful in 19 of 22 lesions, and insertion of the
radioactive source wire was successful at all treated sites.
Angiographic study at 24 hours demonstrated early late loss of the
luminal diameter from 1.92±0.55 to 1.40±0.27 mm. Between 30 and
60 days, repeat angiography demonstrated total occlusion in 2 arteries,
a new pseudoaneurysm in 1 artery, and significant dilatation at
the treatment site in 2 additional vessels. At 
6 months' follow-up,
all remaining arteries (n=20) maintained patent, with a mean lumen
diameter of 1.65±0.8 mm. The calculated late lumen loss was
0.27±0.56 mm, and the late loss index was 0.19. Clinical events
at 1 year included myocardial infarction in 1 patient, repeat
angioplasty to the treated site in 3 patients, and persistent angina in
7 patients.
Conclusions These preliminary results demonstrate that ICRT after coronary intervention is feasible and is associated with an acceptable degree of complications and lower rates of angiographic restenosis indexes.
Key Words: restenosis • angioplasty • radioisotopes • brachytherapy
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