Popowski Y, Verin V, Urban P
Division of Radiation Oncology, University Hospital, Geneva, Switzerland.
Int J Radiat Oncol Biol Phys. 1996 Nov 1;36(4):841-5. doi: 10.1016/s0360-3016(96)00411-7.
Intraluminal beta-irradiation has been shown to markedly decrease fibrointimal proliferation after arterial injury in experimental models. With the aim of reducing the incidence of restenosis after percutaneous transluminal coronary angioplasty (PTCA), we undertook a pilot clinical evaluation to assess both the technical feasibility and the clinical safety of this treatment after balloon coronary angioplasty.
Between June 21 and November 15, 1995, 15 patients (6 women and 9 men, aged 72 +/- 5 years) underwent intracoronary beta-irradiation immediately after a conventional PTCA procedure. Both the PTCA and irradiation procedure were done in a conventional catheterization laboratory, using an endoluminally centered pure metallic 90Y source, a newly developed technique of intracoronary beta-irradiation. This was done after documenting the ability of the system to generate reproducible dose delivery to the arterial wall.
Both the PTCA and the irradiation procedure were technically feasible in all attempted cases, and a dose of 18 Gy was delivered with a local exposure time of 391 +/- 206 s (range 153-768). In four patients, the intervention was completed by intraarterial stent implantation because of dissection induced by the initial PTCA. No in-hospital complications occurred, and serial creatine kinase measurements remained within the normal range in all cases.
Our early experience thus suggests that reliable and reproducible dose delivery can be achieved, and that coronary endoluminally centered beta-brachytherapy is both feasible and safe on a short-term basis in the clinical setting. Whether this novel mode of therapy will favorably influence post-PTCA restenosis in patients, as it does in experimental models, must await long-term angiographic follow-up of the present series as well as further clinical study.
在实验模型中，腔内β射线照射已被证明可显著减少动脉损伤后的纤维内膜增生。为降低经皮腔内冠状动脉成形术（PTCA）后再狭窄的发生率，我们进行了一项初步临床评估，以评估球囊冠状动脉成形术后这种治疗方法的技术可行性和临床安全性。
1995年6月21日至11月15日期间，15例患者（6例女性和9例男性，年龄72±5岁）在常规PTCA术后立即接受冠状动脉内β射线照射。PTCA和照射操作均在常规导管室进行，使用腔内居中的纯金属90Y源，这是一种新开发的冠状动脉内β射线照射技术。在记录系统向动脉壁输送可重复剂量的能力后进行此操作。
在所有尝试的病例中，PTCA和照射操作在技术上均可行，给予18 Gy的剂量，局部暴露时间为391±206秒（范围153 - 768秒）。4例患者因初始PTCA引起的夹层而通过动脉内支架植入完成干预。未发生院内并发症，所有病例的系列肌酸激酶测量值均保持在正常范围内。
因此，我们的早期经验表明，可以实现可靠且可重复的剂量输送，并且冠状动脉腔内居中的β近距离放射治疗在临床环境中短期内既可行又安全。这种新的治疗模式是否会像在实验模型中那样对患者PTCA后的再狭窄产生有利影响，必须等待本系列的长期血管造影随访以及进一步的临床研究。
