Leissner G G, Wengenmair H, Sciuk J, Woelfle K-D, Winterstein A, Weinrich K, Bohndorf K, Wohlgemuth W A
Klinik für Diagnostische Radiologie und Neuroradiologie, Klinikum Augsburg.
Rofo. 2011 Aug;183(8):735-42. doi: 10.1055/s-0031-1273446. Epub 2011 Jul 28.
Restenosis remains a major problem in percutaneous transluminal angioplasty (PTA) of peripheral arteries. The aim of this feasibility study was to evaluate the technical feasibility and safety of a new endovascular brachytherapy (EVBT) device with Rhenium-188 in restenosis prophylaxis of infrainguinal arteries.
From March 2006 to April 2009, 52 patients with 71 infrainguinal arterial lesions were treated with Re-188 to prevent restenosis after PTA. 40 patients with 53 lesions (24 de-novo lesions and 29 restenoses) were reexamined (clinic, color-coded duplex ultrasound) after a mean follow-up period of 12.7 months (2.6 to 25.1 months). The liquid beta-emitter Re-188 was introduced to the target lesion via an EVBT certified PTA balloon and a tungsten applicator. After the calculated irradiation time, Re-188 was aspirated back into the tungsten applicator. A dose of 13 Gy was applied at a depth of 2 mm into the vessel wall.
After a mean follow-up of 12.7 months, the overall restenosis rate after Re-PTA was 15.1 % (8 / 53 lesions). The restenosis rate for de-novo lesions was 20.8 % (5 / 24) and 10.3 % for restenoses (3 / 29). In 4 patients reintervention was necessary (3 PTAs and 2 major amputations). No periprocedural complications were observed. No elevated radiation dose for the patient or the interventionalist was measured.
EVBT with a Re-188 filled balloon catheter was technically feasible and safe after PTA of infrainguinal arterial lesions with restenosis rates lower than expected compared to published results. Treatment of restenoses seems to be more effective than de-novo lesions.
再狭窄仍是外周动脉经皮腔内血管成形术（PTA）中的一个主要问题。本可行性研究的目的是评估一种新型含铼 - 188的血管内近距离放射治疗（EVBT）装置在预防股腘动脉再狭窄方面的技术可行性和安全性。
2006年3月至2009年4月，对52例患者的71个股腘动脉病变进行了铼 - 188治疗以预防PTA后的再狭窄。对40例患者的53处病变（24处原发病变和29处再狭窄病变）在平均随访12.7个月（2.6至25.1个月）后进行了复查（临床检查、彩色编码双功超声）。液态β发射体铼 - 188通过经EVBT认证的PTA球囊和钨制施源器引入目标病变部位。在计算的照射时间后，将铼 - 188吸回到钨制施源器中。在血管壁2mm深度处给予13Gy的剂量。
平均随访12.7个月后，铼 - PTA后的总体再狭窄率为15.1%（8/53处病变）。原发病变的再狭窄率为20.8%（5/24），再狭窄病变的再狭窄率为10.3%（3/29）。4例患者需要再次干预（3次PTA和2次大截肢）。未观察到围手术期并发症。未检测到患者或介入医生的辐射剂量升高。
对于股腘动脉病变进行PTA后，使用含铼 - 188的球囊导管进行EVBT在技术上是可行且安全的，与已发表结果相比，再狭窄率低于预期。再狭窄病变的治疗似乎比原发病变更有效。
