Endovascular brachytherapy for prophylaxis of restenosis after femoropopliteal angioplasty - Results of a prospective randomized study

Background-inasmuch as endovascular brachytherapy (BT) has gained recent in terest because of its inhibitory effect on mechanisms leading to restenosis after percutaneous transluminal angioplasty (PTA), we performed this rando mized study to determine its efficacy for prophylaxis of restenosis after f emoropopliteal PTA. Methods and Results-One hundred thirteen patients (63 men, 50 women; mean a ge 71 years) with de novo or recurrent femoropopliteal lesions were include d in this randomized trial comparing the restenosis rate after PTA plus BT (57 patients, PTA+BT group) versus PTA (56 patients, PTA group) without ste nt implantation. The mean treated length was 16.7 cm (PTA+BT group) versus 14.8 cm (PTA group). In patients randomized to PTA plus BT,a dose of 12 Cy was applied by an Ir-192 source 3 mm from the source axis. Follow-up examin ations included measurement of the ankle-brachial index, color-flow duplex sonography, and angiography. The primary end point of the study was patency after 6 months. The overall recurrence rate after 6 months was 15 (28.3%) of 53 in the PTA+BT group versus 29 (53.7%) of 54 in the PTA group (chi (2) test, P<0.05). The cumulative patency rates at 12 months of fellow-up were 63.6% in the PTA+BT group and 35.3% in the PTA group (log-rank test, P<0.0 05). Conclusions-This is the first randomized study to demonstrate the efficacy of endovascular BT for prophylaxis of restenosis after femoropopliteal PTA. The value of this approach should now be improved by modification of the B T procedure and by combination with stent implantation.