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(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
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Abstract |
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 Top Abstract IntroductionMethods and ResultsDiscussionReferences |
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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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Introduction |
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TopAbstractIntroductionMethods and ResultsDiscussionReferences |
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Thrombotic occlusion after PTCA is associated with increased morbidity and mortality rates.1 Current techniques of stenting followed by antiplatelet therapy have dramatically reduced the incidence of this event to <1.5%.2 3
Intracoronary radiation is a promising new therapy to prevent restenosis. Recent randomized trials demonstrated a reduction in the restenosis rate and maintenance of benefits up to 2-year follow-up.4 5 6 Presently, limited data are available regarding long-term safety after intracoronary brachytherapy.5 7 Although subacute thrombosis has been reported after radiotherapy,4 8 9 the incidence of late thrombotic events has not been determined.
The aim of this study was to document the incidence of late (>1 month) thrombotic events after elective PTCA followed by intravascular radiotherapy.
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Methods and Results |
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TopAbstractIntroductionMethods and ResultsDiscussionReferences |
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From April 1997 to March 1999, 108 consecutive patients were successfully treated with catheter-based intracoronary ß-radiation at the Thoraxcenter (Rotterdam, The Netherlands). The Medical Ethical Committee approved the use of radiation therapy and informed consent was obtained from every patient. All patients presented with stable angina pectoris and single vessel disease. Brachytherapy was performed using the Beta-Cath system (Novoste Corporation)10 (n=76 patients, 32 stents and 44 balloon angioplasty [BA]), or the Guidant intravascular brachytherapy system (Guidant Corporation Vascular Intervention)11 (n=32 patients, 13 Stents and 19 BA). BA and stenting were performed according to standard techniques. Intravascular ultrasound (IVUS) was performed after radiation with a mechanical ultrasound catheter (CVIS, Boston Scientific). Off-line quantitative coronary angiography was performed using CAAS system (Pie Medical Imaging BV). Six-month angiographic and IVUS follow-up was scheduled in all patients.
All patients were discharged without complications. Ninety-one patients completed at least 2-month clinical follow-up. We observed 1 case of subacute thrombosis occurring 15 days after stenting. This patient received an 18-mm long stent (postdilated at 10 atm) with optimal IVUS result. Ticlopidine withdrawal (12 days after stenting) was the plausible explanation of thrombosis in this case.
Six patients (6.6%) presented with sudden late
thrombotic coronary occlusion. Two of them were treated with BA
and the remaining 4 received an additional stent after radiation. Their
clinical characteristics are summarized in the Table
. No
clinical or anatomic characteristic appeared to be related to these
events.
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In patient 1, overlapping 9- and 32-mm NIR stents (Medinol Ltd) were optimally implanted as assessed by IVUS. Patients 2 and 3 (BA) showed type B dissections without compromising flow postprocedure. Patients 4 and 5 both received a Multilink 25-mm stent (Advanced Cardiovascular Systems/Guidant), and patient 6 received a NIR 16-mm stent with optimal angiographic results. Stent patients were discharged on aspirin (250 mg/d) and ticlopidine (250 mg BID for 15 days in patients 3 and 4, and for 30 days in cases 5 and 6). BA patients received aspirin alone.
Patient 1 was readmitted with ventricular
fibrillation 2 months after the procedure, whereas, patients 2, 5, and
6 sustained inferior myocardial infarctions (MI) between
2.5 and 3 months after the treatment. The irradiated segment was
occluded at 6-month angiogram in patients 1 and 2 (Figure 1). Thrombotic occlusion was successfully
treated by primary angioplasty in patients 5 and 6.
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In patient 3, the 6-month IVUS control revealed a persistent
(unhealed) submedial dissection (Figure 2) with no signs of restenosis.
Nine months later, this patient sustained a posterolateral MI which was
treated with thrombolytics. Two weeks after this
treatment, an angiogram performed because of recurrent angina showed
the occlusion in the irradiated area. Similarly, the 6-month IVUS
control of patient 4 showed no neointimal hyperplasia. Four
months after control, she had a stroke and aspirin was replaced by
acenocoumarol. Ten days later, she sustained an anterior MI. The
thrombotic occlusion in the treated site was confirmed by
angiography.
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Discussion |
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TopAbstractIntroductionMethods and ResultsDiscussionReferences |
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Progression to total occlusion after BA is a stable process in the general nonirradiated population which occurs in approximately 4% of patients, leading to a MI in <0.5%.12 In contrast, our study shows a high incidence (6.6%) of thrombotic clinical events 2 to 15 months after PTCA and brachytherapy.
Coronary dissection after BA is associated with abrupt closure; however, type B dissections (NHLBI classification), as observed after BA in our patients, have not been related to thrombotic events.13 The normal healing process, present after dissections, may be impaired after intracoronary radiation.14 Whether unhealed dissections, as demonstrated in patient 3, is related to late thrombosis remains to be elucidated in a larger population. Further, the necessity of stenting mild dissections without compromising flow after radiotherapy should be investigated.
The mean time of subacute thrombosis after stenting is approximately 5 to 6 days.2 3 In a recent study, subacute thrombosis occurred within the first 24 hours in 86% of patients treated with aspirin and ticlodipine for 14 days, with no case of thrombotic events occurring after 15 days.15 Colombo et al reported only 2 cases (0.6%) of thrombosis occurring 2 to 6 months after stenting.2 In contrast, in our study, 4 patients receiving a stent (8.8%) experienced thrombosis late after radiation.
Experimentally, reendothelialization after injury takes >4 weeks to be completed.16 However, the clinical presentation of subacute thrombosis infrequently occurs later than 15 days after stenting,15 when the reendothelialization process may still be incomplete. Delayed reendothelialization as a trigger mechanism of late stent thrombosis after antineoplastic therapy has been hypothesized previously.17 Farb et al reported incomplete endothelialization 3 months after placement of ß-radioactive stent.18 Nevertheless, the same group showed no differences regarding endothelial cell growth between radioactive and control stents in another experimental model.19 Further studies should address the timing of stent reendothelialization after brachytherapy to determine its role on the pathogenesis of late thrombosis.
Although multiple stents have been related to subacute thrombosis,20 the significance of multiple stent implantation (patient 1) on late thrombotic phenomena has not been demonstrated.
The use of intracoronary ß-radiation is a common feature in our patients. However, the judgment of whether radiation is the key factor in the pathogenesis of late thrombosis should await the analysis of ongoing trials. Concomitantly, the benefit of prolonged antiplatelet therapy with the combination of aspirin, clopidogrel, or ticlopidine should be considered.
Limitations
Our patients were included in well-controlled ß-radiation
studies with similar baseline characteristics and inclusion criteria
(lesion length <15 mm, treatment of single vessel). However, 2
different systems to deliver ß-radiation were used.
In addition, it is not possible to rule out the natural history of coronary disease as a cause of late thrombosis. However, the incidence of total occlusion in the general nonirradiated population is much lower than that observed in our study. In fact, the incidence of late thrombotic events would be even higher if, in the interest of completeness, we waited for 1-year follow-up in the total patient population.
Finally, whether late thrombosis is a generic complication of intracoronary radiotherapy or is restricted to the use of ß-sources cannot be extrapolated from our findings.
Received May 10, 1999; revision received June 12, 1999; accepted June 24, 1999.
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J. E. Sousa, M. A. Costa, A. Abizaid, A. G.M.R. Sousa, F. Feres, L. A. Mattos, M. Centemero, G. Maldonado, A. S. Abizaid, I. Pinto, et al. Sirolimus-Eluting Stent for the Treatment of In-Stent Restenosis: A Quantitative Coronary Angiography and Three-Dimensional Intravascular Ultrasound Study Circulation, January 7, 2003; 107(1): 24 - 27. [Abstract] [Full Text] [PDF]
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E. Cheneau, R. Waksman, H. Yazdi, R. Chan, J. Fourdnadjiev, C. Berzingi, V. Shah, A. E. Ajani, L. Leborgne, and F. O. Tio How to Fix the Edge Effect of Catheter-Based Radiation Therapy in Stented Arteries Circulation, October 22, 2002; 106(17): 2271 - 2277. [Abstract] [Full Text] [PDF]
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T. Kataoka, E. Grube, Y. Honda, Y. Morino, S.-H. Hur, H. N. Bonneau, A. Colombo, C. Di Mario, G. Guagliumi, K. E. Hauptmann, et al. 7-Hexanoyltaxol-Eluting Stent for Prevention of Neointimal Growth: An Intravascular Ultrasound Analysis From the Study to COmpare REstenosis rate between QueST and QuaDS-QP2 (SCORE) Circulation, October 1, 2002; 106(14): 1788 - 1793. [Abstract] [Full Text] [PDF]
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M. Degertekin, P. W. Serruys, D. P. Foley, K. Tanabe, E. Regar, J. Vos, P. C. Smits, W. J. van der Giessen, M. van den Brand, P. de Feyter, et al. Persistent Inhibition of Neointimal Hyperplasia After Sirolimus-Eluting Stent Implantation: Long-Term (Up to 2 Years) Clinical, Angiographic, and Intravascular Ultrasound Follow-Up Circulation, September 24, 2002; 106(13): 1610 - 1613. [Abstract] [Full Text] [PDF]
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S. H. Duda, B. Pusich, G. Richter, P. Landwehr, V. L. Oliva, A. Tielbeek, B. Wiesinger, J. B. Hak, H. Tielemans, G. Ziemer, et al. Sirolimus-Eluting Stents for the Treatment of Obstructive Superficial Femoral Artery Disease: Six-Month Results Circulation, September 17, 2002; 106(12): 1505 - 1509. [Abstract] [Full Text] [PDF]
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P.W. Serruys, G. Sianos, W. van der Giessen, H.J.R.M. Bonnier, P. Urban, W. Wijns, E. Benit, M. Vandormael, R. Dorr, C. Disco, et al. Intracoronary {beta}-radiation to reduce restenosis after balloon angioplasty and stenting. The Beta Radiation In Europe (BRIE) study Eur. Heart J., September 1, 2002; 23(17): 1351 - 1359. [Abstract] [Full Text] [PDF]
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R. Waksman, A. E. Ajani, E. Pinnow, E. Cheneau, L. Leborgne, R. Dieble, A. B. Bui, L. F. Satler, A. D. Pichard, K. K. Kent, et al. Twelve Versus Six Months of Clopidogrel to Reduce Major Cardiac Events in Patients Undergoing {gamma}-Radiation Therapy for In-Stent Restenosis: Washington Radiation for In-Stent restenosis Trial (WRIST) 12 Versus WRIST PLUS Circulation, August 13, 2002; 106(7): 776 - 778. [Abstract] [Full Text] [PDF]
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P. W. Serruys, M. Degertekin, K. Tanabe, A. Abizaid, J. E. Sousa, A. Colombo, G. Guagliumi, W. Wijns, W. K. Lindeboom, J. Ligthart, et al. Intravascular Ultrasound Findings in the Multicenter, Randomized, Double-Blind RAVEL (RAndomized study with the sirolimus-eluting VElocity balloon-expandable stent in the treatment of patients with de novo native coronary artery Lesions) Trial Circulation, August 13, 2002; 106(7): 798 - 803. [Abstract] [Full Text] [PDF]
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D. J. Cohen, R. S. Cosgrove, R. H. Berezin, P. S. Teirstein, M. B. Leon, R. E. Kuntz, and on behalf of the Gamma-1 Investigators Cost-Effectiveness of Gamma Radiation for Treatment of In-Stent Restenosis: Results From the Gamma-1 Trial Circulation, August 6, 2002; 106(6): 691 - 697. [Abstract] [Full Text] [PDF]
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T. C. McCowan and M. L. Baker Brachytherapy: Hot or Not Radiology, August 1, 2002; 224(2): 323 - 324. [Full Text] [PDF]
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K. Krueger, P. Landwehr, M. Bendel, M. Nolte, H. Stuetzer, R. Bongartz, M. Zaehringer, G. Winnekendonk, A. Gossmann, R.-P. Mueller, et al. Endovascular Gamma Irradiation of Femoropopliteal de Novo Stenoses Immediately after PTA: Interim Results of Prospective Randomized Controlled Trial Radiology, August 1, 2002; 224(2): 519 - 528. [Abstract] [Full Text] [PDF]
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D. Meerkin, M. Joyal, J.-C. Tardif, J. Lesperance, A. Arsenault, G. Lucier, and R. Bonan Two-Year Angiographic Follow-Up of Intracoronary Sr90 Therapy for Restenosis Prevention After Balloon Angioplasty Circulation, July 30, 2002; 106(5): 539 - 543. [Abstract] [Full Text] [PDF]
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E. Regar, K. Kozuma, G. Sianos, V.L.M.A. Coen, W.J. van der Giessen, D. Foley, P. de Feyter, B. Rensing, P. Smits, J. Vos, et al. Routine intracoronary beta-irradiation. Acute and one year outcome in patients at high risk for recurrence of stenosis Eur. Heart J., July 1, 2002; 23(13): 1038 - 1044. [Abstract] [Full Text] [PDF]
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L. Gruberg, R. Waksman, A. E. Ajani, H.-S. Kim, R. L. White, E. E. Pinnow, L. F. Satler, A. D. Pichard, K. M. Kent, and J. Lindsay Jr The effect of intracoronary radiation for the treatment of recurrent in-stent restenosis in patients with diabetes mellitus J. Am. Coll. Cardiol., June 19, 2002; 39(12): 1930 - 1936. [Abstract] [Full Text] [PDF]
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D. O. Williams Intracoronary Brachytherapy: Past, Present, and Future Circulation, June 11, 2002; 105(23): 2699 - 2700. [Full Text] [PDF]
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M. A. Grise, V. Massullo, S. Jani, J. J. Popma, R. J. Russo, R. A. Schatz, E. M. Guarneri, S. Steuterman, D. A. Cloutier, M. B. Leon, et al. Five-Year Clinical Follow-Up After Intracoronary Radiation: Results of a Randomized Clinical Trial Circulation, June 11, 2002; 105(23): 2737 - 2740. [Abstract] [Full Text] [PDF]
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Y. Morino, T. Limpijankit, Y. Honda, A. J. Lansky, R. Waksman, H. N. Bonneau, P. G. Yock, G. S. Mintz, and P. J. Fitzgerald Late Vascular Response to Repeat Stenting for In-Stent Restenosis With and Without Radiation: An Intravascular Ultrasound Volumetric Analysis Circulation, May 28, 2002; 105(21): 2465 - 2468. [Abstract] [Full Text] [PDF]
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 R. Waksman, A. E. Ajani, R. L. White, R. C. Chan, L. F. Satler, K. M. Kent, A. D. Pichard, E. E. Pinnow, A. B. Bui, S. Ramee, et al. Intravascular Gamma Radiation for In-Stent Restenosis in Saphenous-Vein Bypass Grafts N. Engl. J. Med., April 18, 2002; 346(16): 1194 - 1199. [Abstract] [Full Text] [PDF]
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K. Kozuma, M.A. Costa, W.J. van der Giessen, M. Sabate, J.M.R. Ligthart, V.L.M.A. Coen, I.P. Kay, A.J. Wardeh, A.H.M. Knook, P.J de Feyter, et al. Initial observation regarding changes in vessel dimensions after balloon angioplasty and stenting followed by catheter-based {beta}-radiation. Is stenting necessary in the setting of catheter-based radiotherapy? Eur. Heart J., April 2, 2002; 23(8): 641 - 649. [Abstract] [Full Text] [PDF]
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H. C. Lowe, S. N. Oesterle, and L. M. Khachigian Coronary in-stent restenosis: Current status and future strategies J. Am. Coll. Cardiol., January 16, 2002; 39(2): 183 - 193. [Abstract] [Full Text] [PDF]
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N.G. Uren, S.P. Schwarzacher, J.A. Metz, D.P. Lee, Y. Honda, A.C. Yeung, P.J. Fitzgerald, and P.G. Yock Predictors and outcomes of stent thrombosis. An intravascular ultrasound registry Eur. Heart J., January 2, 2002; 23(2): 124 - 132. [Abstract] [Full Text] [PDF]
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R Mansfield, S Bown, and J McEwan Photodynamic therapy: shedding light on restenosis Heart, December 1, 2001; 86(6): 612 - 618. [Full Text] [PDF]
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P. S. Teirstein and R. E. Kuntz New Frontiers in Interventional Cardiology: Intravascular Radiation to Prevent Restenosis Circulation, November 20, 2001; 104(21): 2620 - 2626. [Full Text] [PDF]
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P. K. Coussement, H. de Leon, T. Ueno, M. Y. Salame, S. B. King III, N. A.F. Chronos, and K. A. Robinson Intracoronary {beta}-Radiation Exacerbates Long-Term Neointima Formation in Balloon-Injured Pig Coronary Arteries Circulation, November 13, 2001; 104(20): 2459 - 2464. [Abstract] [Full Text] [PDF]
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R. Beyar and A. Roguin The sirolimus coated stent: will the Achilles heel of interventional cardiology finally be cured? Eur. Heart J., November 2, 2001; 22(22): 2054 - 2057. [PDF]
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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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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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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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