Long-Term Outcomes after Treatment of Diffuse In-Stent Restenosis with Rotational Atherectomy Followed by Beta-Radiation Therapy with a 188Re-MAG3-Filled Balloon.
10.4070/kcj.2004.34.10.930
- Author:
Sung Joo OH
1
;
Seong Wook PARK
;
Myeong Ki HONG
;
Young Hak KIM
;
Seung Whan LEE
;
Min Kyu KIM
;
Bong Ki LEE
;
Dae Hyuk MOON
;
Seung Jun OH
;
Cheol Whan LEE
;
Jae Joong KIM
;
Seung Jung PARK
Author Information
1. Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. swpark@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Coronary restenosis;
Brachytherapy;
Atherectomy, coronary
- MeSH:
Atherectomy, Coronary*;
Beta Particles;
Brachytherapy;
Constriction, Pathologic;
Coronary Restenosis;
Coronary Vessels;
Follow-Up Studies;
Humans;
Myocardial Infarction
- From:Korean Circulation Journal
2004;34(10):930-936
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND AND OBJECTIVES: Intracoronary radiation therapy for in-stent restenosis has been demonstrated to reduce restenosis and major adverse cardiac events. However, the long-term angiographic and clinical outcomes after beta radiation therapy have not been sufficiently evaluated. SUBJECTS AND METHODS: The long-term angiographic and clinical outcomes of 50 consecutive patients who had received beta-radiation therapy with an 188Re-MAG3-filled balloon after rotational atherectomy for diffuse in-stent restenosis (lesion length>10 mm) in native coronary arteries were evaluated. The radiation dose was 15 Gy at a depth of 1.0 mm into the vessel wall. RESULTS: The mean lesion length was 25.6+/-12.7 mm. Radiation was delivered successfully to all patients, without any procedural or in-hospital complications. At the 6-month angiogram, the restenosis rate was 10% (5/50). There were no major adverse cardiac events (MACE), such as death, myocardial infarction or target lesion revascularization (TLR), by the 6-month follow-up. Long-term clinical data were obtained from all patients during 30.1+/-4.5 months of follow-up. No myocardial infarction and one noncardiac death occurred during follow-up. A two-year follow-up angiogram was performed in 26 (58%) of 45 patients that showed a patent radiation segment at the 6-month angiogram. Significant narrowing of the diameter stenosis greater than 50% occurred in 6 (23%) of 26 patients between 6- and 24-months after the beta-radiation. Late TLR was performed in 6 patients. The rate of 30-month death-free survival and MACE-free survival were 98.0+/-2.0 and 86.9+/-5.0%, respectively. CONCLUSION: Beta-radiation using an 188Re-MAG3-filled balloon after rotational atherectomy is associated with favorable long-term angiographic and clinical outcomes.
