ENDOVASCULAR IRRADIATION - A NEW METHOD TO AVOID RECURRENT STENOSIS AFTER STENT IMPLANTATION IN PERIPHERAL ARTERIES - TECHNIQUE AND PRELIMINARY-RESULTS

Purpose: A high dose rate (HDR) afterloading technique for prevention of vascular stenosis or occlusion after percutaneous transluminal arte riography and subsequent stent implantation caused by intimal hyperpla sia is presented. Methods and Materials: The frequency of recurrent st enosis or occlusion following implantation of stents into peripheral a rteries is relatively high. The cause of relapse is rapid intimal hype rplasia. To prevent proliferation of the intimal layer, intravascular brachytherapy was performed in cases of recurrent vascular occlusion o r severe stenosis. After recanalization by percutaneous transluminal a ngioplasty and stent implantation, a 9-French-ReKa catheter was placed within the lumen of the stent. This catheter served as a guide for a 5-French flexible applicator. Then after individual calculation of the isodose, 12 Gy were applied to the vessel wall. This procedure was fo llowed by 72 h of heparinization. Follow-up by Doppler digital subtrac tion angiography and magnetic resonance imaging was done 3, 6, and 12 months after the procedure and later on once a year. Results: Intralum inal irradiation was performed in 13 patients (nine male and four fema le). All patients had a clinically relevant restenosis or reocclusion in the superficial femoral artery (clinical stage according to Fontain e IIb-III). Follow-up time ranged from 3-27 months. After irradiation the stented area remained patent in all cases and there were no signs of recurrent stenosis in the treated arterial segment. Conclusion: Wit h high dose rate Ir-192 afterloading after percutaneous transluminal a ngioplasty and subsequent stent implantation restenosis or reocclusion caused by intimal hyperplasia can be prevented.