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Intracoronary Radiation Therapy (IRT) for In-Stent Restenosis
차동훈 대한심장학회 2004 Korean Circulation Journal Vol.34 No.1
The efficacy of beta and gamma emitters in reducing clinical and angiographic restenosis in patients with in-stent restenosis has been confirmed by a number of studies. This review is intended to give an overview of the individual trials, summarize pertinent lessons that have been learned and give insight into the future of intracoronary radiation. The encouraging results from the clinical trials have established vascular brachytherapy as a standard of care for patients with in-stent restenosis.
차동훈,Ron Waksman,Augusto D. Pichard,Lowell F. Satler,Kenneth M. Kent,Joseph Lindsay 대한심장학회 2004 Korean Circulation Journal Vol.34 No.1
Background: Cutting Balloon angioplasty (CBA) may be a useful treatment modality for in-stent restenosis (ISR) as it maintains a stable position during dilatation and results in potentially less injury than plain old balloon angioplasty (POBA). The purpose of this study was to compare CBA and POBA with intracoronary radiation therapy (IRT) for in-stent restenosis (ISR). Methods: We selected 157 consecutive patients from the WRIST (Washington Radiation for In-stent restenosis Trial) series of gamma radiation trials using both gamma and beta emitters for ISR of native coronaries or saphenous vein grafts, who were treated with CBA or POBA as the only treatment strategy before intracoronary radiation therapy. Patients in the CBA (N=64) and POBA (N=93) groups were matched for baseline demographic and procedural characteristics. Radiation was delivered successfully in all cases. Results: At angiographic follow up, acute gain was higher in the CBA group than the POBA group (1.7±0.7 mm vs. 1.4±0.9 mm, p=0.03). The angiographic restenosis rate (17.1% vs. 23.5%, p=NS) and edge restenosis rate (6.3% vs. 12.2%, p=NS) were not significantly lower in the cutting balloon cohort. At a 6 month clinical follow up, the CBA group showed a statistically decreased rate of clinically driven target vessel revascularization compared to the POBA group (5.7% vs.18.3%, p=0.038). Conclusions: Cutting balloon angioplasty is a reasonable treatment strategy for in-stent restenosis prior to intracoronary radiation therapy. (Korean Circulation J 2004;34 (1):28-34)