Heuser Richard, Laskey Warren, Lansky Alexandra, Popma Jeffrey, Bonan Raoul
Cardiovascular Research, St Joseph's Hospital and Medical Center/Phoenix Heart Center, Phoenix, AZ 85006, USA.
J Invasive Cardiol. 2003 Nov;15(11):641-3.
Following conventional treatment of in-stent restenosis, clinical restenosis may be as high as 60% in long lesions. Results of the START (Stents and Radiation Therapy) trial indicate that intracoronary beta radiation yields significant reductions in the incidence of recurrent in-stent restenosis as compared with placebo.
In a subgroup of the START trial, results in patients with coronary lesions > 15 mm in length (n = 239) were analyzed to assess treatment with a 30 mm, beta radiation source train. Patients received an intracoronary catheter with (90)Strontium/(90)Yttrium (n = 128) or placebo (n = 111). Clinical and angiographic parameters were evaluated at 8 months. Patient demographics and angiographic lesion characteristics were similar between the 2 groups. The mean lesion lengths were comparable in the radiation and placebo groups (21.5 5.2 mm versus 22.1 5.5 mm, respectively; p = 0.3873). A total of 14.1% and 22.5% of patients in the radiation and placebo groups, respectively, received new stents (p = 0.09). At 8 months, radiation therapy yielded significant reductions in major adverse cardiac events (16.4% versus 29.7%; p = 0.014), target vessel revascularization (14.8% versus 28.8%; p = 0.0085) and target lesion revascularization (11.7% versus 27.9%; p = 0.0015). There was no stent thrombosis, and binary restenosis rates were significantly lower in the radiation group compared to placebo.
Intracoronary beta radiation may prevent early recurrent restenosis in long lesions. Additional study is required to determine if the reduction persists throughout mid- to long-term follow-up.
在支架内再狭窄的传统治疗后，长病变的临床再狭窄率可能高达60%。START（支架与放射治疗）试验结果表明，与安慰剂相比，冠状动脉内β射线放射可显著降低支架内再狭窄复发的发生率。
在START试验的一个亚组中，分析了冠状动脉病变长度>15mm的患者（n = 239）的结果，以评估使用30mmβ射线放射源导管的治疗效果。患者接受含（90）锶/（90）钇的冠状动脉导管（n = 128）或安慰剂（n = 111）。在8个月时评估临床和血管造影参数。两组患者的人口统计学特征和血管造影病变特征相似。放射组和安慰剂组的平均病变长度相当（分别为21.5±5.2mm和22.1±5.5mm；p = 0.3873）。放射组和安慰剂组分别有14.1%和22.5%的患者接受了新支架植入（p = 0.09）。在8个月时，放射治疗显著降低了主要不良心脏事件（16.4%对29.7%；p = 0.014）、靶血管血运重建（14.8%对28.8%；p = 0.0085）和靶病变血运重建（11.7%对27.9%；p = 0.0015）的发生率。未发生支架血栓形成，与安慰剂相比，放射组的二元再狭窄率显著更低。
冠状动脉内β射线放射可预防长病变早期再狭窄复发。需要进一步研究以确定这种降低在中长期随访中是否持续存在。
