Dilcher Christian, Satler Lowell F, Pichard Augusto D, Kent Kenneth M, Porrazzo Michael, Chan Rosanna, Torguson Rebecca, Canos Daniel A, Waksman Ron
Division of Cardiology, Washington Hospital Center, Washington, DC, USA.
Cardiovasc Revasc Med. 2005 Apr-Jun;6(2):52-7. doi: 10.1016/j.carrev.2005.03.002.
Intracoronary beta-radiation therapy reduces in-stent restenosis (ISR). We aimed to determine the safety and feasibility of intracoronary radiation therapy (IRT) utilizing tungsten (188W), a beta emitter.
A total of 30 patients with angiographic evidence of ISR in a previously treated native coronary artery underwent percutaneous coronary intervention (PCI; balloon angioplasty, ablation by atherectomy, or laser angioplasty). After the intervention, a noncentered delivery catheter with a side guide 0.014-in. wire carrying a tungsten (188W) coil, with an active length of 33 mm, was inserted. Patients were randomized to a radiation dose of 18, 22, or 25 Gy at 2 mm from the center of the source. Aspirin and Plavix, at 300 mg loading dose, were administered prior to intervention. Plavix 75 mg/day was prescribed for 6 months after the procedure.
At 6 months follow-up, the overall binary angiographic restenosis rate was 18.8%. Target vessel revascularization (TVR) was 23% and target lesion revascularization related major adverse cardiac events (TLR-MACE) was 13.3%, without any intergroup differences. A comparison with the original Washington Radiation for In-stent restenosis Trial (WRIST) radiation cohort utilizing an 192Iridium source (prescription dose 15 Gy at 2 mm from the source) showed similar TVR and TLR-MACE rates of 30% and 18%, respectively. The TVR and TLR-MACE rates in the WRIST placebo cohort were 70% and 66%, respectively.
Vascular brachytherapy with tungsten (188W) is feasible and safe. The 6-month clinical outcomes are similar to the original WRIST radiation group.
冠状动脉内β射线放射治疗可降低支架内再狭窄（ISR）。我们旨在确定使用β发射体钨（188W）进行冠状动脉内放射治疗（IRT）的安全性和可行性。
共有30例先前治疗的自身冠状动脉存在ISR血管造影证据的患者接受了经皮冠状动脉介入治疗（PCI；球囊血管成形术、旋切术或激光血管成形术）。介入治疗后，插入一根带有0.014英寸侧导丝的非中心输送导管，该导丝携带一个有效长度为33 mm的钨（188W）线圈。患者被随机分配至距源中心2 mm处接受18、22或25 Gy的放射剂量。介入治疗前给予阿司匹林和氯吡格雷，负荷剂量为300 mg。术后给予氯吡格雷75 mg/天，持续6个月。
在6个月的随访中，总体二元血管造影再狭窄率为18.8%。靶血管血运重建（TVR）率为23%，靶病变血运重建相关主要不良心脏事件（TLR-MACE）率为13.3%，组间无差异。与最初使用铱192（192Iridium）源的华盛顿支架内再狭窄放射治疗试验（WRIST）放射治疗队列（距源2 mm处处方剂量为15 Gy）相比，TVR和TLR-MACE率分别相似，为30%和18%。WRIST安慰剂队列中的TVR和TLR-MACE率分别为70%和66%。
使用钨（188W）进行血管近距离放射治疗是可行且安全的。6个月的临床结果与最初的WRIST放射治疗组相似。
