Nguyen-Ho Phong, Kaluza Grzegorz L, Zymek Pawel T, Raizner Albert E
The Methodist DeBakey Heart Center and Baylor College of Medicine, Houston, Texas, USA.
Catheter Cardiovasc Interv. 2002 Jun;56(2):281-8. doi: 10.1002/ccd.10260.
Patients presenting with in-stent restenosis have an increased risk of need for repeat intervention. Intracoronary brachytherapy is indicated for these patients to prevent recurrent in-stent restenosis. Three intravascular brachytherapy systems are currently FDA-approved for use in patients: one utilizing gamma-radiation (Cordis) and two using beta-radiation (Novoste and Guidant). Current evidence and labeling do not support using intracoronary brachytherapy for prevention of restenosis in de novo lesions. Brachytherapy is absolutely contraindicated in patients unable to take prolonged combination antiplatelet drugs. Aspirin and a thienopyridine should be taken for 6 months if no new stent is placed and 12 months if a new stent is placed. If possible, new stent implementation should be avoided.
出现支架内再狭窄的患者再次干预的需求风险增加。冠状动脉内近距离放射治疗适用于这些患者以预防复发性支架内再狭窄。目前有三种血管内近距离放射治疗系统已获美国食品药品监督管理局（FDA）批准用于患者：一种利用伽马射线（Cordis），两种使用贝塔射线（Novoste和Guidant）。目前的证据和标签不支持将冠状动脉内近距离放射治疗用于预防初发病变中的再狭窄。对于无法服用长期联合抗血小板药物的患者，近距离放射治疗绝对禁忌。如果未植入新支架，应服用阿司匹林和噻吩并吡啶6个月；如果植入了新支架，则应服用12个月。如果可能，应避免植入新支架。
