Comparison of angiographic and clinical outcomes between rotational atherectomy versus balloon angioplasty followed by radiation therapy with a rhenium-188-mercaptoacetyltriglycine-filled balloon in the treatment of diffuse in-stent restenosis

被引:2
作者
Lee, SW
Park, SW
Hong, MK
Lee, JH
Kim, YH
Moon, DH
Oh, SJ
Lee, CW
Kim, JJ
Park, SJ
机构
[1] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Med, Seoul 138736, South Korea
[2] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Nucl Med, Seoul 138736, South Korea
关键词
rotational atherectomy; balloon angioplasty; radiation therapy; restenosis;
D O I
10.1016/j.ijcard.2004.04.011
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The purpose of this study was to compare the efficacy of rotational atherectomy (RA) with simple balloon angioplasty, prior to beta-radiation therapy with a rhenium-188-mercaptoacetyltriglycine (Re-188-MAG,)-filled balloon for diffuse in-stent restenosis (ISR). Methods: After completing 50 cases with RA prior to beta-radiation (Group 1), we performed optimal balloon angioplasty followed by beta-radiation in the next 53 consecutive patients (Group 11) for the treatment of diffuse ISR. The radiation dose was 15 Gy at a depth of 1.0 mm into the vessel wall. Results: The baseline clinical and angiographic characteristics were similar between the two groups. The mean length of the lesion was 25.6 +/- 12.7 mm in Group I and 22.9 +/- 8.6 mm in Group 11 (p=0.26). Radiation was successfully delivered to all patients, with a mean irradiation time of 179 +/- 55 s. The 6-month angiographic restenosis rate was 10% (5150) in Group I versus 33% (17/51) in Group 11 (p=0.007). No adverse event including myocardial infarction, death, or stent thrombosis occurred during the I-year follow-up period. The risk of a target lesion revascularization or a major adverse cardiac event was significantly lower in Group I than in Group 11 (two patients in Group I vs. nine patients in Group 11; OR, 0.20; 95% Cl, 0.04-0.96; p=0.04). Conclusion: Concomitant treatment with rotational atherectomy and beta-irradiation using a Re-188-MAG,-filled balloon for diffuse ISR has a synergistic effect, in terms of 6-month angiographic restenosis and 1-year cardiac event-free survival. (c) 2004 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:179 / 185
页数:7
相关论文
共 29 条
[1]   Cutting balloon angioplasty for the treatment of in-stent restenosis: A matched comparison with rotational atherectomy, additional stent implantation and balloon angioplasty [J].
Adamian, M ;
Colombo, A ;
Briguori, C ;
Nishida, T ;
Marsico, F ;
Di Mario, C ;
Albiero, R ;
Moussa, I ;
Moses, JW .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2001, 38 (03) :672-679
[2]   Intravascular ultrasound assessment of the mechanism of lumen enlargement during cutting balloon angioplasty treatment of in-stent restenosis [J].
Ahmed, JM ;
Mintz, GS ;
Castagna, M ;
Weissman, NJ ;
Pichard, AD ;
Satler, LF ;
Kent, KM .
AMERICAN JOURNAL OF CARDIOLOGY, 2001, 88 (09) :1032-+
[3]   Device selection in the treatment of in-stent restenosis with and without radiation (from the gamma radiation trials) [J].
Ajani, AE ;
Waksman, R ;
Zimarino, M ;
Kim, HS ;
Pichard, AD ;
Satlar, LF ;
Kent, KM ;
White, RL ;
Pinnow, E ;
Mehran, R ;
Lansky, A ;
Lindsay, J .
AMERICAN JOURNAL OF CARDIOLOGY, 2002, 89 (02) :137-144
[4]   Stenting the stent:: Initial results and long-term clinical and angiographic outcome of coronary stenting for patients with in-stent restenosis [J].
Alfonso, F ;
Cequier, A ;
Zueco, J ;
Morís, C ;
Suárez, CP ;
Colman, T ;
Esplugas, E ;
Pérez-Vizcayno, MJ ;
Fernández, C ;
Macaya, C .
AMERICAN JOURNAL OF CARDIOLOGY, 2000, 85 (03) :327-332
[5]  
Antoniucci D, 2000, CATHETER CARDIO INTE, V49, P376, DOI 10.1002/(SICI)1522-726X(200004)49:4<376::AID-CCD5>3.0.CO
[6]  
2-O
[7]   Debulking does not benefit patients undergoing intracoronary beta-radiation therapy for in-stent restenosis: Insights from the START trial [J].
Bass, TA ;
Gilmore, P ;
Zenni, M ;
Sasseen, B ;
Savage, M ;
Bonan, R ;
Laskey, W ;
Popma, JJ ;
Costa, MA .
CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2003, 58 (03) :331-335
[8]   Late coronary occlusion after intracoronary brachytherapy [J].
Costa, MA ;
Sabaté, M ;
van der Giessen, WJ ;
Kay, IP ;
Cervinka, P ;
Ligthart, JMR ;
Serrano, P ;
Coen, VLMA ;
Levendag, PC ;
Serruys, PW .
CIRCULATION, 1999, 100 (08) :789-792
[9]   Mechanical debulking versus balloon angioplasty for the treatment of diffuse in-stent restenosis [J].
Dauerman, HL ;
Baim, DS ;
Cutlip, D ;
Sparano, AM ;
Gibson, CM ;
Kuntz, RE ;
Carrozza, JP ;
Garber, GR ;
Cohen, DJ .
AMERICAN JOURNAL OF CARDIOLOGY, 1998, 82 (03) :277-284
[10]   A RANDOMIZED COMPARISON OF CORONARY-STENT PLACEMENT AND BALLOON ANGIOPLASTY IN THE TREATMENT OF CORONARY-ARTERY DISEASE [J].
FISCHMAN, DL ;
LEON, MB ;
BAIM, DS ;
SCHATZ, RA ;
SAVAGE, MP ;
PENN, I ;
DETRE, K ;
VELTRI, L ;
RICCI, D ;
NOBUYOSHI, M ;
CLEMAN, M ;
HEUSER, R ;
ALMOND, D ;
TEIRSTEIN, PS ;
FISH, RD ;
COLOMBO, A ;
BRINKER, J ;
MOSES, J ;
SHAKNOVICH, A ;
HIRSHFELD, J ;
BAILEY, S ;
ELLIS, S ;
RAKE, R ;
GOLDBERG, S .
NEW ENGLAND JOURNAL OF MEDICINE, 1994, 331 (08) :496-501