Beta irradiation adjunct to angioplasty may help with complex lesions

Endovascular brachytherapy with liquid beta-emitting rhenium-188 showed promising results in preventing restenosis in long-segment femoropopliteal in-stent stenosis, according to study results.

The retrospective review was conducted from July 2009 to April 2011 and included 90 consecutive patients with in-stent stenosis or in-stent occlusion >10 cm, or lesions <10 cm if they had recurred at least twice in the femoropopliteal segment.

Liquid beta-emitting rhenium-188 at a dose of 13 Gy was applied to the target lesion (mean lesion length, 24.6 cm) within an angioplasty balloon at a depth of 2 mm into the vessel wall. Patients were followed for up to 2 years to examine 6- and 12-month primary patency rates defined as <50% in-stent stenosis. Cumulative rates of death, amputation and bypass surgery were tracked, as well as improvement in the Rutherford category and the ankle-brachial index.

Primary technical success was achieved in all patients, with one early stent thrombosis, but there were no other complications related to the irradiation. Eighty-eight patients reached the 6-month endpoint with a primary patency of 95.2%. Eighty-two patients reached the 12-month endpoint with 79.8% patency.

In-stent stenosis occurred in nine patients, whereas 10 experienced re-occlusion of the treated segment. The researchers reported two late acute thrombotic occlusions, both after stopping clopidogrel (Plavix, Sanofi-Aventis).

“Despite encouraging results, gamma radiation has scarcely become established in the clinical routine, mainly due to the complex radiation safety measurements,” the researchers wrote. “An advantage of [endovascular brachytherapy] with beta irradiation is that no additional radiation protection is necessary in the cath lab, which means that brachytherapy can be performed in the same room immediately after angioplasty.”

Published by:

Sources/Disclosures

Collapse

Source: Werner M. J Endovasc Ther. 2012;19:467-475.