Document Detail


Optimizing dosimetry with high-dose intracoronary gamma radiation (21 Gy) for patients with diffuse in-stent restenosis.
MedLine Citation:
PMID:  16275606     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The efficacy of intracoronary gamma radiation (IRT-gamma) in reducing recurrent in-stent restenosis (ISR) is well established using doses of 14-18 Gy. We sought to examine whether an escalation in dose to 21 Gy is safe and confers additional benefit in reducing repeat revascularization and major adverse cardiac events (MACE) in patients with diffuse ISR. METHODS: Forty-seven patients with diffuse ISR (lesion length 20-80 mm) in native coronary arteries (n=25) and saphenous vein grafts (n=22) underwent percutaneous transluminal coronary angioplasty and/or additional stents followed by IRT-gamma using the Checkmate system (Cordis) with a dose of 21 Gy. All patients were discharged with clopidogrel for 12 months and aspirin indefinitely. Six-month angiographic and 12-month clinical outcomes of these patients were compared to 120 patients treated with 18 Gy using the same system. RESULTS: At baseline, patients in the 21-Gy group had more multivessel, vein graft disease and history of prior myocardial infarctions and coronary artery bypass grafts (P<.001). The use of debulking devices and stents was less in this group (P<.001). Procedural and in-hospital complications were similar. Follow-up at 6 months revealed nonsignificant but lower late loss (in-stent, 0.33+/-0.7 mm; in-lesion, 0.41+/-0.6 mm) in the 21-Gy group compared to the 18-Gy group; follow-up at 12 months revealed a trend toward less overall myocardial infarction, although repeat revascularization and MACE rates were similar. CONCLUSIONS: IRT-gamma therapy for diffuse ISR lesions with a 21-Gy dose is clinically safe and feasible with marked reduction in late loss but does not confer additional benefit with regard to repeat revascularization and MACE when compared to a dose of 18 Gy.
Authors:
Pramod Kuchulakanti; Rebecca Torguson; Daniel Canos; Lowell F Satler; William Suddath; Rossana Chan; Larry R White; Natalie Gevorkian; Anh Bui; Betty Wang; Kenneth M Kent; Augusto D Pichard; Ron Waksman
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Cardiovascular revascularization medicine : including molecular interventions     Volume:  6     ISSN:  1553-8389     ISO Abbreviation:  -     Publication Date:    2005 Jul-Sep
Date Detail:
Created Date:  2005-11-08     Completed Date:  2006-05-11     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  101238551     Medline TA:  Cardiovasc Revasc Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  108-12     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Department of Medicine, Washington, DC 20010, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary
Blood Vessel Prosthesis Implantation
Coronary Angiography
Coronary Artery Disease / radiotherapy,  surgery
Coronary Restenosis / radiotherapy*,  surgery*
Disease-Free Survival
Dose-Response Relationship, Radiation
Female
Follow-Up Studies
Gamma Rays / adverse effects,  therapeutic use*
Humans
Male
Middle Aged
Postoperative Complications / epidemiology,  etiology
Radiometry
Saphenous Vein / radiation effects,  transplantation
Stents*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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