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49th Annual Scientific Session of the American College of Cardiology, March 2000, Anaheim, California
- Absence of Late Coronary Occlusions After Beta Radiation Following a Modified Antiplatelet Regimen in 120 Consecutive Patients.
- S. Silber, I. Krischke, N. Seidel, A. Schneider, P. von Rottkay
- J Am Coll Cardiol 35: 2A (2000)
Currently, beta radiation is being increasingly applied in Europe as clinical treatment of in-stent restenosis. Recently, however, there was considerable concern regarding the risk of late coronary occlusion after brachytherapy, which was reported to occur in up to 7 % of the cases. This important side effect of intracoronary radiation may be related to delayed endothelialization following radiation therapy. It may thus be hypothesized that a prolonged (> 3 months) prescription of clopidogrel may reduce the risk of late coronary occlusion in patients with and without stents after brachytherapy.
We report our experience in 120 consecutive patients who received intracoronary brachytherapy with the Novoste™ Beta-Cath System for de-novo lesions, restenosis without stents and in-stent restenosis. Mean age was 60.5±9 years, LV-EF was 61±10%, reference diameter was 3.0±0.6 mm; MLD before and directly after radiation was 0.6±0.36 respectively 2.8±0.4 mm. The dose for coronary vessels with a diameter of 2.7-3.35 mm is 14 Gy; for 3.36-4.0 mm is 18 Gy. Mean duration of radiation with 14 Gy was 173±8 s (165-187 s) and 222 ± 12 s (212-240 s) with 18 Gy. The 5F catheter led neither to dissections nor to clinically relevant myocardial ischemia. Coronary overdosing did not occur, but in two patients the pellets got stuck in the guiding catheter for less than 10 s. The additional time needed for the radiation procedure after PTCA was 18±6 min. No acute or subacute stent/occlusion occurred; no later coronary occlusions were reported.
Conclusions: Prolonged application of clopidogrel for at least 3 months seems to be necessary to reduce the risk of late coronary occlusion following intracoronary brachytherapy.
