Endovascular brachytherapy for prevention of recurrence after PTA

Purpose: Recurrent stenosis after PTA is caused by intimal hyperplasia and constrictive arterial remodeling. In experimental and first clinical studie s, ionizing radiation has demonstrated its potential to control excessive i ntimal proliferation. We wanted to evaluate the safety,feasibility and effi cacy of endoluminal irradiation after PTA and/or stent implantation. Material and methods: From September 1996, 24 patients (24 lesions) who had a stenosis or occlusion measuring more than 5 cm in length in the superfic ial femoral artery ora restenosis after PTA underwent endoluminal irradiati on. An isodose of 14 Gy was applied to the vessel wall using an Ir-192-HDR afterloading unit. The radiation was tolerated well;the additional time nee ded for the procedure was 30-45 min. Results: In a mean follow-up time of 15 months we found a cumulative patenc y rate of 60%. No side effects were observed. Conclusion:Endovascular brachytherapy is a safe and brief procedure. In our selection of patients, a patency rate of approx. 40% after 1 year has to b e expected. Thus, these first results are promising,although first publishe d studies of endoluminal irradiation in peripheral vessels with stent impla ntation showed higher patency rates. No randomized data are currently avail able. We conclude that endovascular irradiation should be performed togethe r with stent implantation in long lesions or recurrent stenosis after PTA, in order to control not only excessive intimal proliferation but also const rictive arterial remodeling.