Vol 62, No 6 (2005)
Other
Published online: 2005-12-12
Effectiveness and determinants of the long-term β intracoronary brachytherapy results
DOI: 10.33963/v.kp.81618
Kardiol Pol 2005;62(6):552-557.
Abstract
Background: Effectiveness evaluation and search for the factors determining long-term results of β intracoronary brachytherapy (ICBT) are of a special importance in an upcoming era of drug- eluting stents usage for a wide range of clinical indications: de novo and in-stent restenosis lesions.
Methods.: One hundred forty eight consecutive patients (59.6±9.6 years, 72% men) treated with β ICBT for in-stent restenosis (ISR) or de novo lesions were studied. There were 135 ISR in 121 patients and 31 de novo lesions in 27 patients. Follow-up coronary angiography was performed in all patients after a mean of 8.9±4.5 months. Detailed qualitative and quantitative angiographic analysis of pre-, peri- and postprocedural as well as follow-up angiograms was performed.
Results: Forty five percent of patients treated for de novo lesions were diabetic. Thirty five percent of all targets were located in vessels with a reference vessel diameter <2.5 mm. Furthermore, 77% of ISR lesions were in Class >1 according to the Mehran classification. The mean length of an irradiated segment was 37.6 mm. The overall recurrent restenosis rate was 28.3%. Multivariate analysis revealed that the reference vessel diameter and the presence of edge injury within the proximal 32P source dose-fall off were the only independent predictors of recurrent restenosis after ICBT (OR 0.46; 95%CI 0.24-0.89; p=0.021 and OR 2.55; 95%CI 1.23-5.25; p=0.011, respectively).
Conclusions: Recurrent restenosis after β intracoronary brachytherapy treatment is negatively associated with the target vessel size. Presence of edge injury within the proximal 32P source dose-fall increases the frequency of recurrent renarrowing after ICBT. Our results indicate that target vessel size should be taken into account in optimising interventional strategy for ISR treatment: drug eluting stents versus intracoronary brachytherpy. Avoidance of edge injury within the proximal 32P source *dose fall- off* is strongly recommended while ICBT application.
Methods.: One hundred forty eight consecutive patients (59.6±9.6 years, 72% men) treated with β ICBT for in-stent restenosis (ISR) or de novo lesions were studied. There were 135 ISR in 121 patients and 31 de novo lesions in 27 patients. Follow-up coronary angiography was performed in all patients after a mean of 8.9±4.5 months. Detailed qualitative and quantitative angiographic analysis of pre-, peri- and postprocedural as well as follow-up angiograms was performed.
Results: Forty five percent of patients treated for de novo lesions were diabetic. Thirty five percent of all targets were located in vessels with a reference vessel diameter <2.5 mm. Furthermore, 77% of ISR lesions were in Class >1 according to the Mehran classification. The mean length of an irradiated segment was 37.6 mm. The overall recurrent restenosis rate was 28.3%. Multivariate analysis revealed that the reference vessel diameter and the presence of edge injury within the proximal 32P source dose-fall off were the only independent predictors of recurrent restenosis after ICBT (OR 0.46; 95%CI 0.24-0.89; p=0.021 and OR 2.55; 95%CI 1.23-5.25; p=0.011, respectively).
Conclusions: Recurrent restenosis after β intracoronary brachytherapy treatment is negatively associated with the target vessel size. Presence of edge injury within the proximal 32P source dose-fall increases the frequency of recurrent renarrowing after ICBT. Our results indicate that target vessel size should be taken into account in optimising interventional strategy for ISR treatment: drug eluting stents versus intracoronary brachytherpy. Avoidance of edge injury within the proximal 32P source *dose fall- off* is strongly recommended while ICBT application.
Keywords: intracoronary brachytherapy - in-stent restenosis
