Ortolani Paolo, Marzocchi Antonio, Gaiba William, Neri Stefano, Marrozzini Cinzia, Palmerini Tullio, Aquilina Matteo, Corlianò Leonardo, Lombardo Enzo, Bunkheila Feisal, Pini Stefania, Sbarzaglia Paolo, Taglieri Nevio, Barbieri Enza, Branzi Angelo
Istituto di Cardiologia Università degli Studi Policlinico S. Orsola-Malpighi Via Massarenti, 9 40138 Bologna.
Ital Heart J Suppl. 2003 Aug;4(8):672-81.
The aim of the study was to evaluate, on single center prospective data, long-term angiographic and clinical results of intracoronary beta (32P) brachytherapy in "real world" patients with high-risk in-stent restenosis lesions.
Sixty-nine consecutive patients (77 lesions) with high-risk in-stent restenosis (mean lesion length 30.3 +/- 16.1 mm, pattern III-IV 57.2%, diabetes 33.3%) treated with percutaneous dilation procedures and beta-radiation therapy, underwent 7-month clinical and angiographic follow-up.
One patient (1.4%) presented with procedural non-Q wave myocardial infarction. At a mean follow-up of 7 +/- 1.5 months, death was observed in 1 patient (1.4%) and non-Q wave myocardial infarction in 3 (4.3%) (in 2 patients, who prematurely discontinued antiplatelet therapy, caused by late coronary thrombosis). Seven-month binary angiographic restenosis occurred in 20 lesions (25.9%) (in-stent restenosis 11.6%). Target lesion and target vessel revascularization occurred in 20 (28.9%) and 21 (30.4%) patients. At follow-up only 12 (17.3%) patients presented with CCS class III-IV angina. After intracoronary beta brachytherapy angiographic restenosis occurred regardless of the vessel size, lesion length and ostial location. On the contrary a high restenosis rate was documented in obstructive lesions.
As applied in routine clinical practice, radiation therapy is safe and effective in the treatment of high-risk in-stent restenosis. In spite of all that, total occlusion at baseline predicts late angiographic restenosis.
本研究旨在基于单中心前瞻性数据，评估“真实世界”中患有高危支架内再狭窄病变的患者接受冠状动脉内β（32P）近距离放射治疗的长期血管造影和临床结果。
69例连续患者（77处病变）患有高危支架内再狭窄（平均病变长度30.3±16.1mm，III-IV型57.2%，糖尿病33.3%），接受经皮扩张术和β放射治疗，进行了7个月的临床和血管造影随访。
1例患者（1.4%）出现术中非Q波心肌梗死。平均随访7±1.5个月时，观察到1例患者（1.4%）死亡，3例（4.3%）出现非Q波心肌梗死（2例患者因晚期冠状动脉血栓形成过早停用抗血小板治疗）。20处病变（25.9%）出现7个月时的二元血管造影再狭窄（支架内再狭窄11.6%）。20例（28.9%）和21例（30.4%）患者发生靶病变和靶血管血运重建。随访时仅12例（17.3%）患者出现CCS III-IV级心绞痛。冠状动脉内β近距离放射治疗后，无论血管大小、病变长度和开口位置如何，均会发生血管造影再狭窄。相反，在阻塞性病变中记录到高再狭窄率。
在常规临床实践中应用时，放射治疗在治疗高危支架内再狭窄方面是安全有效的。尽管如此，基线时的完全闭塞可预测晚期血管造影再狭窄。
