Three-Year Clinical Follow-up Results of Intracoronary Radiation Therapy Using a Rhenium-188-Diethylene-Triamine-Penta-Acetic-Acid-Filled Balloon System

Kwang-Il Kim; Jangwhan Bae; Hyun-Jae Kang; Bon-Kwon Koo; Tae-Jin Youn; Sang-Hyun Kim; In-Ho Chae; Hyo-Soo Kim; Dae-Won Sohn; Byung-Hee Oh; Myoung-Mook Lee; Young-Bae Park; Yun-Shik Choi; Dong-Soo Lee

doi:10.1253/circj.68.532

Clinical Investigation

Three-Year Clinical Follow-up Results of Intracoronary Radiation Therapy Using a Rhenium-188-Diethylene-Triamine-Penta-Acetic-Acid-Filled Balloon System

Kwang-Il Kim, Jangwhan Bae, Hyun-Jae Kang, Bon-Kwon Koo, Tae-Jin Youn, Sang-Hyun Kim, In-Ho Chae, Hyo-Soo Kim, Dae-Won Sohn, Byung-Hee Oh, Myoung-Mook Lee, Young-Bae Park, Yun-Shik Choi, Dong-Soo Lee

Author information

Kwang-Il Kim
Cardiovascular Center, Division of Cardiology, Department of Internal Medicine
Jangwhan Bae
Cardiovascular Center, Division of Cardiology, Department of Internal Medicine
Hyun-Jae Kang
Cardiovascular Center, Division of Cardiology, Department of Internal Medicine
Bon-Kwon Koo
Cardiovascular Center, Division of Cardiology, Department of Internal Medicine
Tae-Jin Youn
Cardiovascular Center, Division of Cardiology, Department of Internal Medicine
Sang-Hyun Kim
Cardiovascular Center, Division of Cardiology, Department of Internal Medicine
In-Ho Chae
Cardiovascular Center, Division of Cardiology, Department of Internal Medicine
Hyo-Soo Kim
Cardiovascular Center, Division of Cardiology, Department of Internal Medicine
Dae-Won Sohn
Cardiovascular Center, Division of Cardiology, Department of Internal Medicine
Byung-Hee Oh
Cardiovascular Center, Division of Cardiology, Department of Internal Medicine
Myoung-Mook Lee
Cardiovascular Center, Division of Cardiology, Department of Internal Medicine
Young-Bae Park
Cardiovascular Center, Division of Cardiology, Department of Internal Medicine
Yun-Shik Choi
Cardiovascular Center, Division of Cardiology, Department of Internal Medicine
Dong-Soo Lee
Department of Nuclear Medicine, Seoul National University College of Medicine

Keywords: Angioplasty, Radioisotopes, Restenosis

JOURNAL FREE ACCESS

2004 Volume 68 Issue 6 Pages 532-537

DOI https://doi.org/10.1253/circj.68.532

Details

Abstract

Background Intracoronary radiation therapy (IRT) prevents recurrent in-stent restenosis, but its long-term safety and efficacy remain uncertain. In the present study, the long-term clinical outcome of IRT using the rhenium-188 (¹⁸⁸Re)-filled balloon system was evaluated. Methods and Results After successful catheter-based treatment of either a de novo or restenotic lesion, 187 patients were randomly assigned to either the radiation (N=104) or the control (N=83) group. The ¹⁸⁸Re-filled balloon system was designed to deliver 17.6 Gy to 1.0-mm tissue depth. Angiographic restenosis was significantly reduced with IRT at 9 months (18.9% vs 45.9%, p<0.001), but the incidence of major adverse cardiac events (MACE) including death, myocardial infarction, and target-vessel revascularization (TVR) by 3 years showed no difference. Lack of clinical benefit might be related to TVR caused by geographic miss (6/22, 28.6%), balloon-induced unhealed dissection (3/22, 13.6%) and late thrombosis (2/22, 9.1%). In the restenotic subgroup (N=39), the MACE rate within 3 years was significantly reduced with IRT (14.3% vs 54.5%, p=0.01). Conclusions IRT using the ¹⁸⁸Re -filled balloon system is safe and technically feasible. Although IRT failed to show favorable outcomes for de novo lesion, the clinical benefits for restenotic lesions seem durable for 3 years. Furthermore, preventing geographic miss and dissection might improve long-term outcomes. (Circ J 2004; 68: 532 - 537)

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