Ortolani Paolo, Marzocchi Antonio, Aquilina Matteo, Gaiba William, Bunkheila Feisal, Neri Stefano, Lombardo Enzo, Marrozzini Cinzia, Pini Stefania, Taglieri Nevio, Sbarzaglia Paolo, Reggiani Maria Letizia Bacchi, Barbieri Enza, Branzi Angelo
Institute of Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, Bologna 40138, Italy.
Cardiovasc Radiat Med. 2004 Apr-Jun;5(2):77-83. doi: 10.1016/j.carrad.2004.06.005.
The effectiveness of coronary radiation therapy for the treatment of in-stent restenosis (ISR) has been established in several randomized clinical trials. The efficacy of this treatment in the general population is less well established.
We report our experience in 118 consecutive patients with nonselected high-risk ISR who had undergone successful percutaneous coronary intervention and brachytherapy with (32)P beta-irradiation and who were prospectively enrolled in a quantitative angiographic and clinical follow-up protocol at 7 months after the index procedure. The aim of this study was to investigate the independent predictor of angiographic restenosis after (32)P brachytherapy treatment.
Of the patients, 28.8% were diabetics. The mean lesion and mean radiated lengths were, respectively, 30.1 +/- 17.2 and 43.8 +/- 16.9 mm. The ISR pattern was diffuse in 96% of the treated lesions; in particular, 22.1% presented an occlusive pattern and 37.1% a proliferative pattern. At follow-up angiographic, restenosis and major adverse cardiac events (MACE) rates were, respectively, 20.8% and 29.6%. The univariate predictors of angiographic restenosis were procedural geographic miss, pattern IV ISR, manual pullback maneuver of the radiation source, preprocedural lesion percentage stenosis and preprocedural lesion MLD. At logistic regression analysis, only geographic miss and pattern IV ISR were independent predictors of post intracoronary radiation therapy (IRT) angiographic restenosis.
These data indicate that 7-month angiographic restenosis after (32)P IRT in complex patients with ISR is not a frequent event and is predicted mainly by an occlusive lesion at baseline and by procedural geographical miss.
冠状动脉放射治疗用于治疗支架内再狭窄（ISR）的有效性已在多项随机临床试验中得到证实。但该治疗方法在普通人群中的疗效尚不明确。
我们报告了连续118例非选择性高危ISR患者的经验，这些患者均成功接受了经皮冠状动脉介入治疗，并接受了（32）Pβ射线近距离放射治疗，且在首次手术后7个月前瞻性地纳入了定量血管造影和临床随访方案。本研究的目的是调查（32）P近距离放射治疗后血管造影再狭窄的独立预测因素。
患者中28.8%为糖尿病患者。平均病变长度和平均放射长度分别为30.1±17.2和43.8±16.9毫米。96%的治疗病变ISR模式为弥漫性；具体而言，22.1%表现为闭塞模式，37.1%为增殖模式。在随访血管造影中，再狭窄率和主要不良心脏事件（MACE）率分别为20.8%和29.6%。血管造影再狭窄的单变量预测因素为手术中的血管造影遗漏、IV型ISR模式、放射源手动回撤操作、术前病变百分比狭窄和术前病变平均最小管腔直径（MLD）。在逻辑回归分析中，只有血管造影遗漏和IV型ISR模式是冠状动脉内放射治疗（IRT）后血管造影再狭窄的独立预测因素。
这些数据表明，在复杂的ISR患者中，（32）P IRT后7个月的血管造影再狭窄并不常见，主要由基线时的闭塞性病变和手术中的血管造影遗漏预测。
