Treatment of diffuse in-scent restenosis with rotational atherectomy followed by radiation therapy with a rhenium-188-mercaptoacetyltriglycine-filledballoon

OBJECTIVES This study was done to evaluate the feasibility and efficacy of beta-radiation therapy with a rhenium-188-mercaptoacetyltriglycine (Re-188- MAG(3))-filled balloon after rotational atherectomy for diffuse in-stent re stenosis (ISR). BACKGROUND Rotational atherectomy has been shown to be safe and efficient f or the treatment of ISR, but the recurrence rate is still high. Intracorona ry beta-irradiation after rotational atherectomy may be a reasonable approa ch to prevent recurrent ISR. METHODS Fifty consecutive patients with diffuse ISR (length > 10 mm) in nat ive coronary arteries underwent rotational atherectomy and adjunctive ballo on angioplasty, followed by beta-irradiation using a Re-188-MAG(3) filled b alloon catheter. The radiation dose was 15 Gy at a depth of 1.0 mm into the vessel wall. RESULTS The mean lengths of the lesion and irradiated segment were 25.6 +/- 12.7 mm and 37.6 +/- 11.2 mm, respectively. Radiation was delivered succes sfully to all patients, with a mean irradiation time of 201.8 +/- 61.7 s. N o adverse event, including myocardial infarction, death or stent thrombosis , occurred during the follow-up period (mean 10.3 +/- 3.7 months), and nont arget vessel revascularization was needed in one patient. The six-month bin ary angiographic restenosis rate was 10.4%, and the loss index was 0.17 +/- 0.31. CONCLUSIONS Beta-irradiation using Re-188-MAG(3) filled balloon after rotat ional atherectomy is safe and feasible in patients with diffuse ISR, and it may improve their clinical and angiographic outcomes. Further prospective, randomized trials are warranted to evaluate the synergistic effect of debu lking and irradiation in patients with diffuse ISR. (C) 2001 by the America n College of Cardiology.