[Endovascular Ir-192 HDR brachytherapy for avoidance of intimal hyperplasia in peripheral vessels after PTA and stent implantation. A 6-year experience].

BACKGROUND

The percutaneous transluminal angioplasty (PTA) is the "golden standard" in the therapy of vessel occlusions due to arteriosclerotic plaques. In spite of all improvements of the technique and the equipment with and without stent implantation there is still a restenosis rate of 40%.

PATIENTS AND METHODS

Endovascular brachytherapy with an iridium-192 HDR source was performed in cases of a restenosis due to intimal hyperplasia which occurred within 6 months after a former PTA. After PTA and stent implantation a 9-French ReKa catheter was positioned with the tip 2 cm below the stent. This catheter served a centering device and as a guide for the 5-French applicator. After determination of the isodose and individual planning a dose of 12 Gy to 3 mm source distance was applied. After this procedure the patient received heparin for 72 hours followed by marcumar.

RESULTS

From May 1990 until June 1996 28 patients (21 male, 7 female) were treated after PTA and stent implantation with endovascular brachytherapy. All patients had clinical relevant restenosis or reocclusion of the arteria femoralis. The follow-up time ranges from 2 to 71 months. Twenty-seven patients had a reasonable follow-up time longer than 6 months. Twenty-five patients could be followed: 4 patients had no or only minimal flow in the treated area, 2 patients moved with an unknown address, 1 patient died without any follow-up examination. No side effects of the radiation appeared.

CONCLUSION

Regarding the small number of patients endovascular brachytherapy with iridium 192 HDR seems to be a save and useful adjuvant treatment form to avoid intimal hyperplasia after PTA.