Korean Circ J.  2003 Aug;33(8):671-679. 10.4070/kcj.2003.33.8.671.

Treatment of Diffuse In-Stent Restenosis Combined with Cutting Balloon Angioplasty and Intracoronary Holmium Brachytherapy

• Kang WC
• Byun YS
• Choi D
• Ko YG
• Park SH
• Koo BK
• Yoon YW
• Jang Y
• Lee JD
• Shim WH
• Cho SY

• KMID: 1858774
• DOI: http://doi.org/10.4070/kcj.2003.33.8.671

Abstract

BACKGROUND AND OBJECTIVES
A cutting balloon angioplasty for the treatment of diffuse in-stent restenosis has been reported to be superior to conventional percutaneous transluminal coronary angioplasty. Intracoronary radiation therapy is also a novel technique for preventing a recurrence of in-stent restenosis following percutaneous coronary intervention. Holmium (166Ho) is a high-energy beta-emitter, which is available in liquid form. We performed a cutting balloon angioplasty, with subsequent intracoronary 166Ho brachytherapy, for the treatment of in-stent restenosis.
SUBJECTS AND METHODS
Fifty two patients, with in-stent restenosis, were treated with cutting balloon angioplasy and intracoronary 166Ho brachytherapy. For the irradiation, a balloon approximately 10 mm longer than the stent was used. Radiation doses of 18 Gy at a depth of 1 mm from balloon-artery interface were used. A quantitative coronary angiography was performed during the procedure and at the 6-month follow-up. The patients were followed clinically for an average of 16.8+/-9.8 months.
RESULTS
The procedures were successful in all patients. The minimal luminal diameter of in-stent restenosis lesions, initially and after treatment, and the lesion length were 0.58+/-0.30 and 2.55+/-0.29 mm, and 20.7+/-7.1 mm, respectively. Thirty four (65.4%) patients completed the angiographic follow-up at 6 months. The minimal luminal diameter of lesion and late loss were 2.03+/-0.83 and 0.57+/-0.79 mm, respectively. The target lesion restenosis rate was 14.7%. No patients presented with MACE, such as MI, death or stent thrombosis.
CONCLUSION
The combination of cutting balloon angioplasty and intracoronary 166Ho brachytherapy was feasible, safe and effective for the treatment of diffuse in-stent restenosis.

Keyword

In-stent restenosis; Cutting balloon angioplasty; Intracoronary 166Ho brachytherapy

MeSH Terms

Angioplasty, Balloon*
Angioplasty, Balloon, Coronary
Brachytherapy*
Coronary Angiography
Follow-Up Studies
Holmium*
Humans
Percutaneous Coronary Intervention
Phenobarbital
Recurrence
Stents
Thrombosis
Holmium
Phenobarbital