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(Circulation. 2002;105:1420.)
© 2002 American Heart Association, Inc.

High-Dose Intravascular ß-Radiation After De Novo Stent Implantation Induces Coronary Artery Spasm

D. Scheinert, MD; V. Strnad, MD; R. Müller, MD; R. Burckhard, MD; S. Ropers, MD; R. Sauer, MD; W.G. Daniel, MD; R. Bonan, MD; J. Ludwig, MD

From the Departments of Cardiology (D.S., R.B., S.R., W.G.D., J.L.), Radiooncology (V.S., R.S.), and Medical Physics (R.M.), University of Erlangen-Nuremberg, Germany; and the Montreal Heart Institute (R.B.), Montreal, Canada.

Correspondence to Dr D. Scheinert, Medizinische Klinik–Kardiologie, Universität Leipzig–Herzzentrum, Strümpellstr. 39, 04289 Leipzig, Germany. E-mail dierk.scheinert{at}gmx.de

Background— Intracoronary brachytherapy is effective in preventing restenosis after coronary interventions. However, in vitro and animal studies have shown that irradiation produces immediate and sustained endothelial dysfunction. This study assesses the clinical relevance of impaired vasomotoric function induced by brachytherapy.

Methods and Results— We analyzed the occurrence of postradiation coronary artery spasms in 1 animal study and 2 clinical trials investigating the effects of high-dose intracoronary ß-radiation after de novo coronary artery stenting. Irradiated segments (IRSs) proximal and distal to the stent were studied by quantitative coronary angiography after stenting, after radiation, and at the end of the procedure. There was an 67% overall incidence of coronary artery spasm in the IRSs immediately after ß-radiation compared with 9% after sham treatment (P<0.001). Whereas in most cases this phenomenon was only minor or moderate, in 12 cases, 4 (22%) animals and 8 (28%) patients, severe coronary spasm (>90% diameter stenosis) with significant ECG-changes or hemodynamic instability was observed. Relief of spasms was protracted (mean time until complete relief of spasm 423±122 seconds) and required repetitive intracoronary administration of nitroglycerin (mean dose: 1.2±0.6 mg).

Conclusions— Vasoconstriction is a frequent reaction of coronary arteries after high-dose intracoronary ß-radiation, necessitating repetitive administration of vasodilators.

Key Words: stents • restenosis • radioisotopes • vasoconstriction

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