(Circulation. 1999;100:789-792.)
© 1999 American Heart Association, Inc.
Brief Rapid Communication |
Late Coronary Occlusion After Intracoronary Brachytherapy
From Thoraxcenter (M.A.C., M.S., W.J.v.d.G., I.P.K., P.C., J.M.R.L., P.S., P.W.S.), Dijkzigt University Hospital, and Daniel den Hoek Cancer Center (V.L.M.A.C., P.C.L.), Rotterdam, The Netherlands.
Correspondence to Prof Patrick W. Serruys, Head of the Department of Interventional Cardiology, University Hospital Dijkzigt-Thoraxcenter Bd418, Dr. Molewaterplein,40–3015GD Rotterdam, The Netherlands. E-mail serruys{at}card.azr.nl
Background—Intracoronary brachytherapy appears to be a promising technology to prevent restenosis. Presently, limited data are available regarding the late safety of this therapeutic modality. The aim of the study was to determine the incidence of late (>1 month) thrombosis after PTCA and radiotherapy.
Methods and Results—From April 1997 to March 1999, we successfully treated 108 patients with PTCA followed by intracoronary ß-radiation. Ninety-one patients have completed at least 2 months of clinical follow-up. Of these patients, 6.6% (6 patients) presented with sudden thrombotic events confirmed by angiography 2 to 15 months after intervention (2 balloon angioplasty and 4 stent). Some factors (overlapping stents, unhealed dissection) may have triggered the thrombosis process, but the timing of the event is extremely unusual. Therefore, the effect of radiation on delaying the healing process and maintaining a thrombogenic coronary surface is proposed as the most plausible mechanism to explain such late events.
Conclusions—Late and sudden thrombosis after PTCA followed by intracoronary radiotherapy is a new phenomenon in interventional cardiology.
Key Words: thrombosis • angioplasty • radioisotopes
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J. E. Sousa, M. A. Costa, A. C. Abizaid, B. J. Rensing, A. S. Abizaid, L. F. Tanajura, K. Kozuma, G. Van Langenhove, A. G.M.R. Sousa, R. Falotico, et al. Sustained Suppression of Neointimal Proliferation by Sirolimus-Eluting Stents: One-Year Angiographic and Intravascular Ultrasound Follow-Up Circulation, October 23, 2001; 104(17): 2007 - 2011. [Abstract] [Full Text] [PDF]
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F Liistro and A Colombo Late acute thrombosis after paclitaxel eluting stent implantation Heart, September 1, 2001; 86(3): 262 - 264. [Abstract] [Full Text] [PDF]
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R. M. Wolfram, B. Pokrajac, R. Ahmadi, C. Fellner, M. Gyongyosi, M. Haumer, R. Bucek, R. Potter, and E. Minar Endovascular Brachytherapy for Prophylaxis against Restenosis after Long-Segment Femoropopliteal Placement of Stents: Initial Results Radiology, September 1, 2001; 220(3): 724 - 729. [Abstract] [Full Text] [PDF]
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S. O. Marx and A. R. Marks Bench to Bedside: The Development of Rapamycin and Its Application to Stent Restenosis Circulation, August 21, 2001; 104(8): 852 - 855. [Full Text] [PDF]
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G. Tepe, L. M. Dinkelborg, U. Brehme, P. Muschick, B. Noll, T. Dietrich, A. Greschniok, A. Baumbach, C. D. Claussen, and S. H. Duda Prophylaxis of Restenosis With 186Re-Labeled Stents in a Rabbit Model Circulation, August 6, 2001; 104(4): 480 - 485. [Abstract] [Full Text] [PDF]
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G. Sianos, I. P. Kay, M. A. Costa, E. Regar, K. Kozuma, P. J. de Feyter, E. Boersma, C. Disco, and P. W. Serruys Geographical miss during catheter-based intracoronary beta-radiation: incidence and implications in the BRIE study J. Am. Coll. Cardiol., August 1, 2001; 38(2): 415 - 420. [Abstract] [Full Text] [PDF]
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Y. Honda, E. Grube, L. M. de la Fuente, P. G. Yock, S. H. Stertzer, and P. J. Fitzgerald Novel Drug-Delivery Stent: Intravascular Ultrasound Observations From the First Human Experience With the QP2-Eluting Polymer Stent System Circulation, July 24, 2001; 104(4): 380 - 383. [Abstract] [Full Text] [PDF]
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 J. Ludemann, K.-L. Schulte, O. Hader, S. Brehme, H.-D. Volk, and W.-D. Docke Leukocyte/Endothelium Activation and Interactions During Femoral Percutaneous Transluminal Angioplasty Vascular and Endovascular Surgery, July 1, 2001; 35(4): 293 - 301. [Abstract] [PDF]
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P. Wexberg, M. Gottsauner-Wolf, I. Sulzbacher, P. Birner, A. Laggner, and D. Glogar Fatal Late Coronary Thrombosis after Implantation of a Radioactive Stent: Postmortem Angiographic and Histologic Findings—Case Report Radiology, July 1, 2001; 220(1): 142 - 144. [Abstract] [Full Text] [PDF]
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A. W. Heldman, L. Cheng, G. M. Jenkins, P. F. Heller, D.-W. Kim, M. Ware Jr, C. Nater, R. H. Hruban, B. Rezai, B. S. Abella, et al. Paclitaxel Stent Coating Inhibits Neointimal Hyperplasia at 4 Weeks in a Porcine Model of Coronary Restenosis Circulation, May 8, 2001; 103(18): 2289 - 2295. [Abstract] [Full Text] [PDF]
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 Z. Chen, K. W. Woodburn, C. Shi, D. C. Adelman, C. Rogers, and D. I. Simon Photodynamic Therapy With Motexafin Lutetium Induces Redox-Sensitive Apoptosis of Vascular Cells Arterioscler Thromb Vasc Biol, May 1, 2001; 21(5): 759 - 764. [Abstract] [Full Text] [PDF]
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G. L. Kaluza, A. E. Raizner, W. Mazur, D. G. Schulz, J. M. Buergler, L. F. Fajardo, F. O. Tio, and N. M. Ali Long-Term Effects of Intracoronary {beta}-Radiation in Balloon- and Stent-Injured Porcine Coronary Arteries Circulation, April 24, 2001; 103(16): 2108 - 2113. [Abstract] [Full Text] [PDF]
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A. Farb, S. Shroff, M. John, W. Sweet, and R. Virmani Late Arterial Responses (6 and 12 Months) After 32P {beta}-Emitting Stent Placement : Sustained Intimal Suppression With Incomplete Healing Circulation, April 10, 2001; 103(14): 1912 - 1919. [Abstract] [Full Text] [PDF]
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A.J Wardeh, A.H.M Knook, I.P Kay, M Sabate, V.L.M.A Coen, D.P Foley, J.N Hamburger, P.C Levendag, W.J van der Giessen, and P.W Serruys Clinical and angiographical follow-up after implantation of a 6-12{micro}Ci radioactive stent in patients with coronary artery disease Eur. Heart J., April 2, 2001; 22(8): 669 - 675. [Abstract] [PDF]
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S. O. Trerotola and L. A. Turmel-Rodrigues Off the Beaten Path: Transbrachial Approach for Native Fistula Interventions Radiology, March 1, 2001; 218(3): 617 - 619. [Full Text]
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V. Verin, Y. Popowski, B. de Bruyne, D. Baumgart, W. Sauerwein, M. Lins, G. Kovacs, M. Thomas, F. Calman, C. Disco, et al. Endoluminal Beta-Radiation Therapy for the Prevention of Coronary Restenosis after Balloon Angioplasty N. Engl. J. Med., January 25, 2001; 344(4): 243 - 249. [Abstract] [Full Text] [PDF]
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M. B. Leon, P. S. Teirstein, J. W. Moses, P. Tripuraneni, A. J. Lansky, S. Jani, S. C. Wong, D. Fish, S. Ellis, D. R. Holmes, et al. Localized Intracoronary Gamma-Radiation Therapy to Inhibit the Recurrence of Restenosis after Stenting N. Engl. J. Med., January 25, 2001; 344(4): 250 - 256. [Abstract] [Full Text] [PDF]
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J. E. Sousa, M. A. Costa, A. Abizaid, A. S. Abizaid, F. Feres, I. M. F. Pinto, A. C. Seixas, R. Staico, L. A. Mattos, A. G. M. R. Sousa, et al. Lack of Neointimal Proliferation After Implantation of Sirolimus-Coated Stents in Human Coronary Arteries : A Quantitative Coronary Angiography and Three-Dimensional Intravascular Ultrasound Study Circulation, January 16, 2001; 103(2): 192 - 195. [Abstract] [Full Text] [PDF]
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 M. Wohlfrom, J. Kotzerke, J. Kamenz, M. Eble, B. Hess, J. Wohrle, S. N Reske, V. Hombach, H. Hanke, and M. Hoher Endovascular irradiation with the liquid {beta}-emitter Rhenium-188 to reduce restenosis after experimental wall injury Cardiovasc Res, January 1, 2001; 49(1): 169 - 176. [Abstract] [Full Text] [PDF]
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C. Di Mario, J. W. Moses, T. J. Anderson, R. Bonan, T. Muramatsu, A. C. Jain, J. Suarez de Lezo, S. Y. Cho, M. Kern, I. T. Meredith, et al. Randomized Comparison of Elective Stent Implantation and Coronary Balloon Angioplasty Guided by Online Quantitative Angiography and Intracoronary Doppler Circulation, December 12, 2000; 102(24): 2938 - 2944. [Abstract] [Full Text] [PDF]
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P.W. Serruys and S.G. Carlier Brachytherapy in the Journal: European cardiologists have their own forum and should use it! Eur. Heart J., December 2, 2000; 21(24): 1994 - 1996. [PDF]
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D. E. Drachman, E. R. Edelman, P. Seifert, A. R. Groothuis, D. A. Bornstein, K. R. Kamath, M. Palasis, D. Yang, S. H. Nott, and C. Rogers Neointimal thickening after stent delivery of paclitaxel: change in composition and arrest of growth over six months J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2325 - 2332. [Abstract] [Full Text] [PDF]
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P. S. Teirstein Fulfilling the Promise of Percutaneous Angioplasty Circulation, November 28, 2000; 102(22): 2674 - 2676. [Full Text] [PDF]
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E. Minar, B. Pokrajac, T. Maca, R. Ahmadi, C. Fellner, M. Mittlbock, W. Seitz, R. Wolfram, and R. Potter Endovascular Brachytherapy for Prophylaxis of Restenosis After Femoropopliteal Angioplasty : Results of a Prospective Randomized Study Circulation, November 28, 2000; 102(22): 2694 - 2699. [Abstract] [Full Text] [PDF]
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E. Minar, R. Wolfram, B. Pokrajac, M. A. Costa, M. Sabate, W. J. van der Giessen, I. P. Kay, P. Cervinka, J. M.R. Ligthart, P. Serrano, et al. Endovascular Brachytherapy and Late Thrombotic Occlusion Response Circulation, November 28, 2000; 102 (22): e175 - e176. [Full Text] [PDF]
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R. Hoffmann and G.S. Mintz Coronary in-stent restenosis--predictors, treatment and prevention Eur. Heart J., November 1, 2000; 21(21): 1739 - 1749. [PDF]
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K R KARSCH and A C NEWBY Stent magic! The genie has escaped from the bottle Heart, November 1, 2000; 84(5): 469 - 470. [Full Text]
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Y. Cottin, M. Kollum, R. Chan, B. Bhargava, Y. Vodovotz, and R. Waksman Vascular repair after balloon overstretch injury in porcine model effects of intracoronary radiation J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1389 - 1395. [Abstract] [Full Text] [PDF]
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A. E. Raizner, S. N. Oesterle, R. Waksman, P. W. Serruys, A. Colombo, Y.-L. Lim, A. C. Yeung, W. J. van der Giessen, L. Vandertie, J. K. Chiu, et al. Inhibition of Restenosis With {beta}-Emitting Radiotherapy : Report of the Proliferation Reduction With Vascular Energy Trial (PREVENT) Circulation, August 29, 2000; 102(9): 951 - 958. [Abstract] [Full Text] [PDF]
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D. Meerkin, J.-C. Tardif, O. F. Bertrand, J. Vincent, F. Harel, and R. Bonan The effects of intracoronary brachytherapy on the natural history of postangioplasty dissections J. Am. Coll. Cardiol., July 1, 2000; 36(1): 59 - 64. [Abstract] [Full Text] [PDF]
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R. Waksman, B. Bhargava, G. S. Mintz, R. Mehran, A. J. Lansky, L. F. Satler, A. D. Pichard, K. M. Kent, and M. B. Leon Late total occlusion after intracoronary brachytherapy for patients with in-stent restenosis J. Am. Coll. Cardiol., July 1, 2000; 36(1): 65 - 68. [Abstract] [Full Text] [PDF]
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J. H. Baron, A. H. Gershlick, K. Hogrefe, J. Armstrong, C. M. Holt, R. K. Aggarwal, M. Azrin, M. Ezekowitz, and D. P. de Bono In vitro evaluation of c7E3-Fab (ReoProTM) eluting polymer-coated coronary stents Cardiovasc Res, June 1, 2000; 46(3): 585 - 594. [Abstract] [Full Text] [PDF]
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J. M. Ahmed, G. S. Mintz, R. Waksman, N. J. Weissman, R. Mehran, A. D. Pichard, L. F. Satler, K. M. Kent, and M. B. Leon Safety of Intracoronary {gamma}-Radiation on Uninjured Reference Segments During the First 6 Months After Treatment of In-Stent Restenosis : A Serial Intravascular Ultrasound Study Circulation, May 16, 2000; 101(19): 2227 - 2230. [Abstract] [Full Text] [PDF]
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R. E. Kuntz and D. S. Baim Prevention of Coronary Restenosis : The Evolving Evidence Base for Radiation Therapy Circulation, May 9, 2000; 101(18): 2130 - 2133. [Full Text] [PDF]
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R. Waksman, R. L. White, R. C. Chan, B. G. Bass, L. Geirlach, G. S. Mintz, L. F. Satler, R. Mehran, P. W. Serruys, A. J. Lansky, et al. Intracoronary {gamma}-Radiation Therapy After Angioplasty Inhibits Recurrence in Patients With In-Stent Restenosis Circulation, May 9, 2000; 101(18): 2165 - 2171. [Abstract] [Full Text] [PDF]
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