| Intracoronary brachytherapy for the prevention of restenosis after percutaneous coronary revascularization. | |
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MedLine Citation:
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PMID: 14597925 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: The purpose of this article is to review the current literature pertaining to intracoronary brachytherapy for the prevention of restenosis after percutaneous coronary revascularization (PCR). METHODS: English-language articles were identified through a MEDLINE search (January 1984 to January 2003) using the keywords brachytherapy, radioactive stents, and coronary arteries. In addition, pertinent reference citations from relevant articles were reviewed. RESULTS: Restenosis after PCR is a complex process, thought to be due to a combination of vessel wall remodeling and neointimal proliferation. To date, catheter-based delivery of intracoronary brachytherapy has been found to prevent vessel wall remodeling and causes a reduction in the proliferation of the neointima. Neointimal proliferation, as measured by mean neointimal area, was reduced in all animal studies (range 26%-91%). In contrast, animal studies examining radioactive stents demonstrated an increase in neointimal proliferation, suggesting that they may not be helpful at preventing post-PCR restenosis. All human studies using catheter-based intracoronary brachytherapy for in-stent restenosis have employed either beta (beta) or gamma (gamma) radiation sources with variable doses of radiation (range 7-56 Grays [Gy]). Restenosis occurred in 12% to 40% of patients in nonrandomized studies, and clinical events occurred in 13% to 50% of patients. To date, there have been 7 published randomized trials in humans comparing catheter-based intracoronary brachytherapy to placebo, with a total of 1047 patients. The dose of radiation in the trials ranged from 14 Gy to 30 Gy. During follow-up, 8% to 33% of patients who received brachytherapy had restenosis versus 39% to 64% of patients receiving placebo. Clinical events occurred in 19% to 50% among patients who received brachytherapy versus 29% to 79% among patients receiving placebo. The majority of human studies examining radioactive stents do not demonstrate a reduction in restenosis in patients post-PCR. There are no randomized trials examining radioactive stents in humans. CONCLUSION: Nonrandomized studies of radioactive stents suggest they are not effective at preventing in-stent restenosis. In contrast, data from animal and human studies suggest that catheter-based intracoronary brachytherapy can prevent in-stent restenosis and reduce clinical events post-PCR. |
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Authors:
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Richard Sheppard; Mark J Eisenberg; David Donath; David Meerkin |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: American heart journal Volume: 146 ISSN: 1097-6744 ISO Abbreviation: Am. Heart J. Publication Date: 2003 Nov |
Date Detail:
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Created Date: 2003-11-04 Completed Date: 2004-02-25 Revised Date: 2006-02-27 |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: United States |
Other Details:
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Languages: eng Pagination: 775-86 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiology, Royal Victoria Hospital, Montreal, Quebec, Canada. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Transluminal, Percutaneous Coronary
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adverse effects* Animals Brachytherapy / adverse effects, methods* Coronary Restenosis / etiology, pathology, prevention & control* Coronary Vessels / pathology, radiation effects Humans Stents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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