Late coronary occlusion after intracoronary brachytherapy

Background-Intracoronary brachytherapy appears to be a promising technology to prevent restenosis, Presently, limited data are available regarding the late safety of this therapeutic modality. The aim of the study was to dete rmine the incidence of late (>1 month) thrombosis after PTCA and radiothera py. Methods and Results-From April 1997 to March 1999, we successfully treated 108 patients with PTCA followed by intracoronary beta-radiation. Ninety-one patients have completed at least 2 months of clinical follow-up. Of these patients, 6.6% (6 patients) presented with sudden thrombotic events confirm ed by angiography 2 to 15 months after intervention (2 balloon angioplasty and 4 stent). Some factors (overlapping stents, unhealed dissection) may ha ve triggered the thrombosis process, but the timing of the event is extreme ly unusual. Therefore, the effect of radiation on delaying the healing proc ess and maintaining a thrombogenic coronary surface is proposed as the most plausible mechanism to explain such late events. Conclusions-Late and sudden thrombosis after PTCA followed by intracoronary radiotherapy is a new phenomenon in interventional cardiology.