Long-term clinical outcome of patients treated with beta-brachytherapy in routine clinical practice (Journal article)

Nikas, D. N./ Kalef-Ezra, J./ Katsouras, C. S./ Tsekeris, P./ Bozios, G./ Pappas, C./ Naka, K. K./ Kotsia, A./ Papamichael, N./ Sideris, D. A./ Michalis, L. K.

Background: Only limited data exist regarding the long-term efficacy of beta-brachytherapy (beta-VBT) in routine clinical practice and the impact of the prolonged (> 6 months) combined antiplatelet therapy after beta-VBT. Our aim is to examine the long-term clinical efficacy of routine beta brachytherapy (beta-VBT) followed by indefinite administration of combined antiplatelet therapy in patients at high restenotic risk. Methods: Sixty-one patients with 65 lesions [de novo: 41, in-stent restenotic (ISR): 24] underwent intracoronary beta-VBT and were followed prospectively. All patients received indefinite administration of aspirin and clopidogrel, underwent routine angiography 6 months later and were followed-up clinically for 43.7 months (range: 32 to 52 months). Results: Acute success was achieved in 60/61 (98.4%) patients. Lesion length was 36.1 (+/- 17.6) mm for the de novo and 22.0 (+/- 9.8) mm for the ISR (p=0.001). Stems were implanted in 35/41 de novo and 7/24 ISR lesions (p < 0.01). Six-month binary restenosis after successful beta-VBT was 35.9% (23/64). During follow-up patients with de-novo lesions who received a new stent during index procedure had a higher incidence of major cardiac events than patients with ISR lesions without a new stent (log rank test, p=0.02). Acute and late thrombotic events were reported at 6 patients, all with de novo lesions and stent implantation. Conclusions: Beta-VBT plus stenting in de novo lesions is related to an unacceptable high rate of thrombotic complications and clinical restenosis despite prolonged administration of combined antiplatelet therapy. Brachytherapy remains a reasonable option for patients with ISR lesions until full data from large randomized trials comparing drug eluting stents with brachytherapy are available. (c) 2006 Elsevier Ireland Ltd. All rights reserved.
Institution and School/Department of submitter: Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών και Τεχνολογιών. Τμήμα Βιολογικών Εφαρμογών και Τεχνολογιών
Keywords: percutaneous coronary interventions,beta-brachytherapy,intravascular brachytherapy,in-stent restenosis,intracoronary gamma-radiation,catheter-based radiotherapy,2-year follow-up,intravascular ultrasound,coronary restenosis,washington radiation,balloon angioplasty,late thrombosis,wrist-plus
URI: https://olympias.lib.uoi.gr/jspui/handle/123456789/17738
ISSN: 0167-5273
Link: <Go to ISI>://000244512800008
http://ac.els-cdn.com/S0167527306003883/1-s2.0-S0167527306003883-main.pdf?_tid=5c502d60-ada2-11e2-92d1-00000aab0f6b&acdnat=1366892542_de869a53bb347fae9b03a85b75d6268d
Appears in Collections:Άρθρα σε επιστημονικά περιοδικά ( Ανοικτά)

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