ENDOVASCULAR IR-192-HDR-BRACHYTHERAPY FOR AVOIDANCE OF INTIMAL HYPERPLASIA IN PERIPHERAL VESSELS AFTER PTA AND STENT-IMPLANTATION

Background: The percutaneous transluminal angioplasty (PTA) is the ''g olden standard'' in the therapy of vessel occlusions due to arterioscl erotic plaques. In spite of all improvements of the technique and the equipment with and without stent implantation there is still a resteno sis rate of 40%. Patients and Methods: Endovascular brachytherapy with an iridium-192 HDR source was performed in cases of a restenosis due to intimal hyperplasia which occurred within 6 months after a former P TA. After PTA and stent implantation a 9-French ReKa catheter was posi tioned with the tip 2 cm below the stent. This catheter served a cente ring device and as a guide for the 5-French appliator. After determina tion of the isodose and individual planning a dose of 12 Gy to 3 mm so urce distance was applied. After this procedure the patient received h eparin for 72 hours followed by marcumar. Results: From May 1990 until June 1996 28 patients (21 male, 7 female) were treated after PTA and stent implantation with endovascular brachytherapy. All patients had c linical relevant restenosis or reocclusion of the arteria femoralis. T he follow-up time ranges from 2 to 71 months. Twenty-seven patients ha d a reasonable follow-up time longer than 6 months. Twenty-five patien ts could be followed: 4 patients had no or only minimal now in the tre ated area, 2 patients moved with an unknown address, 1 patient died wi thout any follow-up examination. No side effects of the radiation appe ared. Conclusion: Regarding the small number of patients endovascular brachytherapy with iridium 192 HDR seems to be a save and useful adjuv ant treatment form to avoid intimal hyperplasia after PTA.