Document Detail


Prevention of coronary restenosis with radiation therapy: a review.
MedLine Citation:
PMID:  12109864     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The problem of restenosis after percutaneous transluminal coronary angioplasty remains the major limiting factor of the procedure. Over the last 10 years, investigators have been studying the use of radiation therapy for preventing restenosis after angioplasty or stent placement. Since radiotherapy has been proven in other cases to be effective in disrupting the cell cycle regulatory proteins and thereby slowing or stopping growth, it was decided to apply the same principle to neointimal hyperplasia. To review the data that have emerged regarding vascular radiation with an emphasis on irradiated stents, 65 articles were reviewed and both preclinical and clinical experiments were included. Overall, studies with gamma and beta radiation show promising results. Endovascular gamma radiation has been shown effective in randomized trials, even at 3-year follow-up. Beta radiation is preferred because of greater safety and localization, and because it has also shown encouraging results in initial clinical trials, as well as in larger randomized studies. Consequently, the Federal Drug Administration has approved the use of both. In both types of endovascular brachytherapy, it seems the greater the dose, the better the initial response. Safety concerns include an increased incidence of late thrombosis and greater restenosis at margins. With irradiated stents, however, the situation is not as clear. At times, animal models have presented confusing results. These have ranged from significant suppression of hyperplasia to outright adverse effects of radiation on the vessel wall. While some clinical trials have been encouraging, others have not. Follow-up of up to 1 year has been disappointing so far. Many issues, such as the "candy wrapper" effect and rebound hyperplasia, must be dealt with before this becomes a viable form of therapy. It has become clear that radiation therapy in this setting, while having potentially great benefits, can cause deleterious effects as well. However, the mixed bag of positive and negative results seen so far, and the attractiveness of stents or percutaneous transluminal coronary angioplasty being "restenosis-proofed," eventually is cause for cautious optimism.
Authors:
Nabeel Hafeez
Related Documents :
17074534 - Serial angiography in patients with acute coronary syndromes: effect of antithrombotic ...
10392864 - Influence of lesion length on restenosis after coronary stent placement.
12959734 - Preliminary experience with the tsunami coronary stent: immediate and six-month clinica...
8213574 - Balloon postdilation can safely improve the results of successful (but suboptimal) dire...
24954194 - Pneumonia, thrombosis and vascular disease.
16488684 - Valve replacement surgery in end-stage renal failure: mechanical prostheses versus biop...
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Clinical cardiology     Volume:  25     ISSN:  0160-9289     ISO Abbreviation:  Clin Cardiol     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-07-11     Completed Date:  2003-01-16     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  313-22     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, University Hospital, State University of New York at Stony Brook, USA. nhafeez@hotmail.com
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Angioplasty, Transluminal, Percutaneous Coronary
Animals
Beta Particles
Brachytherapy / methods*
Coronary Artery Disease / radiotherapy*
Coronary Restenosis / prevention & control*
Gamma Rays
Heart Catheterization
Humans
Radiation Injuries, Experimental
Stents*

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


Previous Document:  Kinetic profiles by topographic compartments in muscle-invasive transitional cell carcinomas of the ...
Next Document:  Low-molecular-weight heparin for the treatment of patients with mechanical heart valves.