ENDOVASCULAR BETA-IRRADIATION AFTER PERCUTANEOUS TRANSLUMINAL CORONARY BALLOON ANGIOPLASTY

Purpose: Intraluminal beta-irradiation has been shown to markedly decr ease fibrointimal proliferation after arterial injury in experimental models, With the aim of reducing the incidence of restenosis after per cutaneous transluminal coronary angioplasty (PTCA), we undertook a pil ot clinical evaluation to assess both the technical feasibility and th e clinical safety of this treatment after balloon coronary angioplasty . Methods and Materials: Between June 21 and November 15, 1995, 15 pat ients (6 women and 9 men, aged 72 +/- 5 years) underwent intracoronary beta-irradiation immediately after a conventional PTCA procedure, Bot h the PTCA and irradiation procedure were done in a conventional cathe terization laboratory, using an endoluminally centered pure metallic Y -90 source, a newly developed technique of intracoronary beta-irradiat ion, This was done after documenting the ability of the system to gene rate reproducible dose delivery to the arterial wall. Results: Both th e PTCA and the irradiation procedure were technically feasible In all attempted cases, and a dose of 18 Gy was delivered with a local exposu re time of 391 +/- 206 s (range 153-768), In four patients, the interv ention was completed by intraarterial stent implantation because of di ssection induced by the initial PTCA, No in-hospital complications occ urred, and serial creatine kinase measurements remained within the nor mal range in all cases. Conclusion: Our early experience thus suggests that reliable and reproducible dose delivery can be achieved, and tha t coronary endoluminally centered beta-brachytherapy is both feasible and safe on a short-term basis in the clinical setting, Whether this n ovel mode of therapy will favorably influence post-PTCA restenosis in patients, as it does in experimental models, must await long-term angi ographic follow-up of the present series as well as further clinical s tudy. Copyright (C) 1996 Elsevier Science Inc.