High-dose intravascular beta-radiation after de novo stent implantation induces coronary artery spasm

Circulation
D ScheinertJ Ludwig

Abstract

Intracoronary brachytherapy is effective in preventing restenosis after coronary interventions. However, in vitro and animal studies have shown that irradiation produces immediate and sustained endothelial dysfunction. This study assesses the clinical relevance of impaired vasomotoric function induced by brachytherapy. We analyzed the occurrence of postradiation coronary artery spasms in 1 animal study and 2 clinical trials investigating the effects of high-dose intracoronary beta-radiation after de novo coronary artery stenting. Irradiated segments (IRSs) proximal and distal to the stent were studied by quantitative coronary angiography after stenting, after radiation, and at the end of the procedure. There was an 67% overall incidence of coronary artery spasm in the IRSs immediately after beta-radiation compared with 9% after sham treatment (P<0.001). Whereas in most cases this phenomenon was only minor or moderate, in 12 cases, 4 (22%) animals and 8 (28%) patients, severe coronary spasm (>90% diameter stenosis) with significant ECG-changes or hemodynamic instability was observed. Relief of spasms was protracted (mean time until complete relief of spasm 423+/-122 seconds) and required repetitive intracoronary administration o...Continue Reading

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Citations

Feb 13, 2004·Progress in Cardiovascular Diseases·Srilakshmi Konidala, David D Gutterman
Sep 17, 2003·Cardiovascular Radiation Medicine·Cezary KepkaAdam Witkowski
Aug 2, 2003·Cardiovascular Radiation Medicine·Dave C Y ChuaGary L Schaer
May 15, 2008·Journal of Medical Imaging and Radiation Oncology·F Schwarz, D Christie
Sep 17, 2003·Cardiovascular Radiation Medicine·Dave C Y ChuaGary L Schaer
Jun 19, 2004·International Journal of Cardiovascular Interventions·Ariel FinkelsteinRaj Makkar
Sep 15, 2006·Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology·Christoph SchukroDietmar Glogar
Apr 16, 2003·Journal of Cardiovascular Electrophysiology·Ron D B Simon, Jaswinder S Gill
Oct 7, 2004·Journal of the American College of Cardiology·Paul ErneTherese Resink

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