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49th Annual Scientific Session of the American College of Cardiology, March 2000, Anaheim, California
- Single-Session Radiation of Two Coronary Arteries for Prevention of Restenosis in de-novo Lesions: Safety Using a 6 Months Protocol of Clopidogrel.
- S. Silber, I. Krischke, N. Seidel, A. Schneider, P. von Rottkay
- J Am Coll Cardiol 35: 49A-50A (2000)
One advantage of beta over gamma radiation is the possibility to radiate several coronary arteries in a single session without the risk of overdosing adjacent vessels. There is, however, concern that radiating two arteries in a single-session could double the risk for late coronary occlusion related to the hampered endothelialization. The risk of "delayed acute thrombosis" may be even higher when stents have been implanted during brachytherapy. To assess the safety and efficacy of single-session beta radiation in patients with multi-vessel disease, we performed a prospective evaluation with the Novoste™ Beta-Cath system in pats with stable angina, objective signs of myocardial ischemia and at least 75% diameter stenoses in two of the major coronary arteries. Starting three days before, all pats received ASS (300mg o.d.) and Clopidogrel (75 mg o.d.) for 6 months. Mean pats age was 56±7 y with a mean LV-EF of 58±13%. A total of 36 de-novo lesions were treated in these 18 pats with two vessel disease; LAD/RCx/RCA lesions were radiated in 39%/33%/28%. For a mean lesion length of 12.4±4.4 mm and a reference diameter of 3.1±0.4mm, the mean MLD was 1.2±0.6 mm before and 2.7±0.3 mm after the intervention. After radiation, stents were implanted in 89% of the lesions with an average stent length of 17±4.4 mm at 10.4±2.2 bar. The administered dose of the Strontium/Yttrium-90 radiation source trains with 12 pellets (30 mm) or 16 pellets (40 mm) was 15±2 Gy (14-18 ) with an exposure time of 181±22 s (169-224). No complications ocurred during PTCA, radiation or stent implantation. All radiation procedures could be finished as planned. Clinical follow-up did not reveal ischemic events, so far.
Conclusions: Beta radiation of two major coronary arteries in a single session is feasible and safe. On a prolonged 6 months protocol for clopidogrel intake, no late coronary occlusions ocurred. The data for MACE and angiographically determined restenosis will be presented.
