(Circulation. 1998;98:2024-2029.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports |
Intracoronary Radiation for Prevention of Restenosis
Dose Perturbations Caused by Stents
From Columbia University, Department of Radiation Oncology (H.I.A., F.T.) and Departments of Medicine and Pharmacology (J.W.), New York, NY.
Background—Intravascular
irradiation with ß-emitters has been proposed for inhibition of
restenosis in coronary arteries after balloon
angioplasty or stent implantation. Previous studies have shown the
effectiveness of 
-radiation to prevent recurrent restenosis,
even in the presence of an implanted stent. The limited range of
ß-particles compared with -radiation, however, opens the question
of whether absorption and scattering of ß-particles by stent struts
will cause significant perturbations in the uniformity and magnitude of
the radiation dose, which may in turn compromise treatment.
Methods and Results—Nine different stents were deployed with a
balloon filled with a ß-emitting radioactive liquid. Dose
distributions were measured with Gafchromic film. Stents varied
significantly in their absorption of ß-particles. Some stents,
constructed of fine meshed wires, produced minimal dose perturbations.
Others, with thicker, high-atomic-number struts, induced cold spots in
the dose distribution adjacent to the wires of 
35%. Average dose
reduction varied from 4% to 14% in the presence of various
stents.
Conclusions—Radiation strategy may have to be tailored to stent
design. Stents that minimally perturb the dose distribution may be
deployed before irradiation. Those that significantly alter the
radiation dose might be better deployed after irradiation. Dose
prescriptions may require modification if such perturbations prove
clinically significant. Observed dose perturbations, however, decreased
rapidly with increasing distance from the stent, which may mitigate the
clinical impact of these findings. This, as well as the effects of
stents on -dose distributions, requires further investigation.
Key Words: angioplasty • restenosis • brachytherapy • stents • beta rays
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