IR-192 ENDOVASCULAR BRACHYTHERAPY FOR AVOIDANCE OF INTIMAL HYPERPLASIA AFTER PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY AND STENT IMPLANTATION IN PERIPHERAL VESSELS - 6 YEARS OF EXPERIENCE

Purpose: Percutaneous transluminal angioplasty (PTA) with or without s tentimplantation is the accepted standard in the therapy of occlusive arterial disease, Despite improvements in the technique and medical eq uipment, there is still a restenosis rate of up to 40%, A high-dose-ra te afterloading technique to avoid vascular stenosis or occlusion afte r PTA and subsequent stent implantation caused by intimal hyperplasia is presented with longterm results. Methods and Materials: Intravascul ar brachytherapy with a 10-Ci Ir-192 source was performed in cases of recurrent vascular occlusion or stenosis which appeared within 6 month s after a previous PTA, After recanalization by PTA and stentimplantat ion, a 9-Fr ReKa catheter was positioned within the stent to center th e applicator with its tip 2 cm below the stent, This catheter served a s a guide for a 5-Fr flexible applicator. After this procedure the iso dose was calculated and a 12-Gy to 3-mm source distance was applied, T he procedure was followed by 72 h of heparinization. Results: From May 1990 to June 1996, 28 patients (21 male and seven female) were treate d with endovascular brachytherapy. All patients had a clinically relev ant restenosis or reocclusion of the arteria femoralis, Follow-up time ranged from 1 to 71 months, Twenty-eight patients had a sufficient fo llow-up time; 25 of these patients were examined, Twenty-one patients had treated vessel segments; four patients had no flow in the treated area, Two patients moved away with unknown addresses, and one patient died without any follow-up examination, Radiation-associated side effe cts were not notable. Conclusion: Intraluminal brachytherapy with Ir-1 92 is a safe and useful procedure to avoid endovascular hyperplasia af ter transluminal percutaneous angioplasty. Copyright (C) 1996 Elsevier Science Inc.