- Treatment of in-stent-restenosis by combining cutting
balloon angioplasty and vascular brachytherapy: a report from
the RENO registry
-
- E. Eeckhout (1), C. Roguelov (1), E. De Benedetti (1), P.
Coucke (1), S. Silber (2), A. Colombo (3), H. Heuer (4), K.H.
Kuck (5), J. Schofer (6), R. Bonan (7)
1, CHUV, Cardiology Dept., Lausanne, Switzerland
2, Müller Hospital, Cardiology Dept., Munich, Germany
3, Heart Center Columbus, Cardiology Dept., Milan, Italy
4, St Johannes Hospital, Cardiology Dept., Dortmund, Germany
5, Allg Krankenhaus St. Georg, Cardiology Dept., Hamburg, Germany
6, Gemeinschaftspraxis Matthey Schofer, Cardiology Dept., Hamburg,
Germany
7, Heart Institute, Cardiology Dept., Montreal, Canada
- Eur Heart J 22, Abstract suppl., 390, (2001)
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The Reno Registry
tracks all patients who are treated by Beta-Cath (Novoste, Brussels,
Belgium) brachytherapy in Europe and who are not included in
another trial. The theoretical advantage of cutting balloon angioplasty
over conventional balloon angioplasty prior to brachytherapy
is the potential to obtain a larger luminal gain and to avoid
balloon slipping which may induce
geographic miss.
Methods: From April 1999 on, 1111 patients have been included
in this Registry. In 173 patients with in-stent-restenosis a
combined approach using cutting balloon angioplasty followed
by coronary b brachytherapy was performed.
Results: Mean age was 62±10 years and 129 were
male (74.6%). 47 patients (27.8%) had diabetes and 23 (14%) had
unstable angina. 93.5% of lesions were located in native coronary
arteries. Reference vessel size was 3.25±0.41 mm and mean
lesion length was 17.5±12.9 mm. Radiation treatment was
performed utilizing a 30 mm (9.8%), 40 mm (81.5%) or 60mm (8.7%)
long
source train, with a mean dwell time of 3.5±0.9 minutes
(mean radiation dose: 20.3±3.2 Gy). Stents were implanted
15.7% of cases. Procedures were successful in 97.3% of cases.
Obvious geographic miss occurred in 4 lesions. During hospitalization,
1 patient died and 1 more patient experienced myocardial infarction
(1.2% adverse events). At the present time, there are no deaths
nor additional myocardial infarctions and angiographic follow-up,
available for 64 patients, demonstrates a restenosis rate of
9.4%. Revascularization was required in 7 patients (9.3%).
Conclusions: these preliminary results indicate the feasibility
and safety of the strategy of combining cutting balloon angioplasty
followed by vascular brachytherapy. More complete follow-up data
will be available at the time of presentation and will illustrate
whether this combined intervention can further reduces restenosis
rates beyond those obtained with brachytherapy only. |
