Grise Mark A, Reilly John P, Tobis Jonathan M, Takano Yuzuru, Currier Jesse W, Kobashigawa Jon A, Weisz Giora, Moses Jeffrey W, Leon Martin B, Yeung Alan, Teirstein Paul S
Division of Cardiovascular Disease, Scripps Clinic, La Jolla, California 92037, USA.
Catheter Cardiovasc Interv. 2003 Sep;60(1):41-4. doi: 10.1002/ccd.10607.
Transplant vasculopathy significantly limits the survival of cardiac transplant patients and occurs in 50% of patients by 5 years posttransplant. We report our experience with six cardiac transplant patients who underwent intracoronary brachytherapy for in-stent restenosis. At four centers, six patients underwent intracoronary radiation for in-stent restenosis. All patients received extended antiplatelet therapy with clopidogrel and aspirin. Follow-up angiography was performed in all patients. Two of the six patients underwent subsequent target lesion revascularization. Patient 1 presented with total occlusion of her radiated lesion. She had a complex procedure requiring stenting for a dissection after the radiation dwell. Patient 2 had high-grade restenosis following brachytherapy. Patient 3 had a 50% restenotic lesion. Patients 4, 5, and 6 had follow-up angiography that showed no evidence of restenosis. There are few good options to treated accelerated transplant vasculopathy. Radiation therapy may be a viable option in this difficult patient population.
移植血管病变显著限制了心脏移植患者的生存，并且在移植后5年内50%的患者会出现该病变。我们报告了6例接受冠状动脉内近距离放射治疗支架内再狭窄的心脏移植患者的情况。在4个中心，6例患者因支架内再狭窄接受了冠状动脉内放射治疗。所有患者均接受了氯吡格雷和阿司匹林的延长抗血小板治疗。对所有患者均进行了随访血管造影。6例患者中有2例随后接受了靶病变血管重建术。患者1出现了放射治疗病变的完全闭塞。她接受了复杂的手术，在放射驻留后因夹层需要置入支架。患者2在近距离放射治疗后出现高度再狭窄。患者3有一个50%的再狭窄病变。患者4、5和6的随访血管造影显示没有再狭窄的迹象。治疗加速性移植血管病变的好选择很少。放射治疗在这个困难的患者群体中可能是一个可行的选择。
