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(Circulation. 2001;104:2620.)
© 2001 American Heart Association, Inc.

Clinical Cardiology: New Frontiers

New Frontiers in Interventional Cardiology

Intravascular Radiation to Prevent Restenosis

Paul S. Teirstein, MD; Richard E. Kuntz, MD MSc

From the Division of Cardiovascular Diseases (P.S.T.), Scripps Clinic, La Jolla, Calif; and the Divisions of Clinical Biometrics and Cardiology (R.E.K.), Brigham and Women’s Hospital, Boston, Mass.

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

Key Words: radioisotopes • restenosis • stents • angioplasty

	Introduction

 
Any antirestenosis therapy under consideration must contend with the two basic mechanisms of vessel renarrowing following coronary intervention.¹ The first renarrowing mechanism is vascular contraction, which can be mechanically blocked with a typical balloon expandable stent. The second renarrowing mechanism, neointimal proliferation, is a complex cellular reaction to the injury caused by the actions of mechanical devices such as balloons, stents, and atherectomy catheters. The search for an effective antiproliferative agent has been long and frustrating. Over 100 drugs and devices have been tested resulting in preclinical or clinical failures.² This legacy of previous failures has made the recent successes of radiotherapy particularly gratifying.

The treatment of restenosis with vascular radiation appears to work through inhibition of smooth muscle cell proliferation. The energy emitted from an active isotope is believed to block mitosis by causing a double-stranded break in the cell’s DNA (Figure 1).^3,4 Thus, by performing surgery on the vascular smooth muscle cell’s DNA, radiation prevents the proliferative ingrowth of tissue that often reblocks the vessel lumen after a successful angioplasty. The United States Food and Drug Administration’s recent premarket approval of two radiation devices has now propelled this first effective antiproliferative treatment into the mainstream of patient care. This report provides an overview of the basic laboratory and clinical data supporting the effectiveness of brachytherapy as well as some of the challenges and controversies surrounding its integration into clinical practice.

View larger version (24K): [in this window] [in a new window]   Figure 1. Diagram of single- and double-stranded DNA breaks caused by radiation. A, Two-dimensional representation of . . . [Full Text of this Article]

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