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(Circulation. 1997;95:1095-1097.)
© 1997 American Heart Association, Inc.

Articles

ß-Radiation to Reduce Restenosis

Too Little, Too Soon?

Paul Teirstein, MD

the Scripps Clinic and Research Foundation, 10666 North Torrey Pines Rd, La Jolla, Calif 92037.

Correspondence to Paul Teirstein, MD, Scripps Clinic and Research Foundation, 10666 North Torrey Pines Rd, La Jolla, CA 92037.

Key Words: Editorials • radioisotopes • restenosis • angioplasty

	Introduction

 
With almost 1 million procedures undertaken worldwide each year, coronary angioplasty is flourishing. This elegant technique, however, continues to be plagued by a restenosis rate of 30% to 60%.¹ Efforts to reduce restenosis have been herculean. Literally, scores of pharmaceutical agents have been tested in clinical trials.^{2 3 4} Despite initial promising results in experiments with animals, each clinical trial has been a disappointment. Coronary stents stand alone as the only intervention that has been proved to decrease restenosis. In the STRESS and BENESTENT trials, the implantation of a single Palmaz-Schatz coronary stent was associated with a 30% reduction in restenosis rates.^{5 6} The impact of stents on restenosis, however, is purely mechanical.^{7 8} Stent implantation expands the vessel lumen further than the use of balloon angioplasty alone. This larger lumen creates more space for the still ubiquitous intimal proliferation. Stents do not diminish the cellular response to injury. In fact, the proliferative response, as measured on the basis of late loss after the procedure, is actually increased by the use of stents. Stents decrease restenosis by simply increasing the capacity of the artery to tolerate intimal proliferation. Despite extensive clinical testing, no agent has been shown to inhibit the proliferative component of restenosis.

Radiotherapy is the latest in a long line of potential antiproliferative agents to be enthusiastically tested as an adjunct to angioplasty. There is much to recommend the use of radiotherapy in the fight against restenosis. In more than 100 years of clinical experience, radiotherapy has proved to be highly effective . . . [Full Text of this Article]

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