一种使用局部递送99mTc-HMPAO治疗冠状动脉支架再狭窄的新型近距离放射疗法。

A novel method of brachytherapy using local delivery of 99mTc-HMPAO for coronary stent restenosis.

作者信息

Kim Weon, Jeong Myung Ho, Kim Sung Hee, Park Woo Seok, Park Ok Young, Kim Ju Han, Bom Hee-Seung, Jeong Hwan Jung, Ahn Young Keun, Cho Jeong Gwan, Park Jong Chun, Kang Jung Chaee

机构信息

The Heart Center, Chonnam National University Hospital, Gwangju, Korea.

出版信息

Korean J Intern Med. 2004 Sep;19(3):179-88. doi: 10.3904/kjim.2004.19.3.179.

DOI:10.3904/kjim.2004.19.3.179

PMID:15481610

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4531558/

Abstract

BACKGROUND

Restenosis after percutaneous coronary intervention (PCI) is a matter that still remains to be resolved. Herein, the inhibitory effect of locally delivered 99mTc-HMPAO (hexamethyl propylene amine oxime) on neointimal hyperplasia after coronary stenting was examined in a pocine model, and its safety and efficacy observed in patients with coronary stent restenosis.

METHODS

After a stent overdilation injury, local radioisotope delivery using 99mTc-HMPAO was applied to one coronary artery (Group I) and control therapy to another (Group II) in each of 10 pigs. Follow-up coronary angiogram (CAG) and histopathologic assessment were performed 4 weeks after stenting. Eleven patients (10 males and one female, 62.4 +/- 5.7 years of age) underwent local administration of 30 mCi/ 2 mL 99mTc-HMPAO shortly after PCI, via a Dispatch Catheter, followed by a whole body scan to evaluate the distribution of the 99mTc-HMPAO, as well as a thallium-201 (TI-201) myocardial scan to evaluate myocardial perfusion. The major adverse cardiac events (MACE) were assessed during a one-year clinical follow-up.

RESULTS

On histopathological analysis, the neointimal areas were 1.2 +/- 0.6 and 2.7 +/- 0.4 mm2 (p=0.002), and the histopathological areas of stenosis were 27.16.3 and 53.4 +/- 5.2% in Groups I and II (p=0.001), respectively. In the clinical study, there was no in-hospital MACE. On a quantitative coronary angiographic analysis, the minimal luminal diameter was increased from 0.4 +/- 0.3 to 2.9 +/- 0.2 mm, and diameter stenosis decreased from 84.2 +/- 9.5 to 16.3 +/- 11.0% following PCI. Follow-up CAG was performed in 9 cases (81.8%) and restenosis occurred in 2 (22.2%). On a follow-up CAG, the minimal luminal diameter, diameter stenosis rate, lumen loss and loss index were 2.0 +/- 0.8 mm, 27.7 +/- 2.9%, 0.7 +/- 0.7 mm and 0.2 +/- 0.3, respectively. During the one-year clinical follow-up there were no cases of death or acute MI, but two cases of target vessel revascularization (18.2%).

CONCLUSION

Local delivery of 99mTc-HMPAO, a novel radiotherapy, can be used safely and effectively for coronary stent restenosis.

摘要

背景

经皮冠状动脉介入治疗（PCI）后的再狭窄仍是一个有待解决的问题。在此，我们在猪模型中研究了局部递送99mTc - HMPAO（六甲基丙烯胺肟）对冠状动脉支架置入术后新生内膜增生的抑制作用，并在冠状动脉支架再狭窄患者中观察了其安全性和有效性。

方法

在10头猪中，每头猪的一条冠状动脉采用99mTc - HMPAO进行局部放射性同位素递送（I组），另一条冠状动脉采用对照治疗（II组），均先进行支架过度扩张损伤。支架置入术后4周进行冠状动脉造影（CAG）随访和组织病理学评估。11例患者（10例男性，1例女性，年龄62.4±5.7岁）在PCI后不久通过Dispatch导管局部给予30mCi/2mL的99mTc - HMPAO，随后进行全身扫描以评估99mTc - HMPAO的分布，并进行铊 - 201（TI - 201）心肌扫描以评估心肌灌注。在一年的临床随访期间评估主要不良心脏事件（MACE）。

结果

组织病理学分析显示，I组和II组的新生内膜面积分别为1.2±0.6和2.7±0.4mm²（p = 0.002），组织病理学狭窄面积分别为27.1±6.3%和53.4±5.2%（p = 0.001）。在临床研究中，住院期间无MACE发生。定量冠状动脉造影分析显示，PCI后最小管腔直径从0.4±0.3mm增加到2.9±0.2mm，直径狭窄从84.2±9.5%降至16.3±11.0%。9例患者（81.8%）进行了CAG随访，2例（22.2%）发生再狭窄。在随访CAG中，最小管腔直径、直径狭窄率、管腔丢失和丢失指数分别为2.0±0.8mm、27.7±2.9%、0.7±0.7mm和0.2±0.3。在一年的临床随访期间，无死亡或急性心肌梗死病例，但有2例（18.2%）进行了靶血管血运重建。