Donate Help Contact The AHA Sign In Home
American Heart Association
Circulation
Search: search_blue_button Advanced Search
« Previous Article | Table of Contents | Next Article »
Circulation. 2001;103:2332-2335

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Waksman, R.
Right arrow Articles by Lindsay, J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Waksman, R.
Right arrow Articles by Lindsay, J.
Related Collections
Right arrow Restenosis
Right arrow Thrombin
Right arrow Catheter-based coronary interventions: stents
Right arrow Other Treatment
Right arrow Platelets

(Circulation. 2001;103:2332.)
© 2001 American Heart Association, Inc.

Brief Rapid Communications

Prolonged Antiplatelet Therapy to Prevent Late Thrombosis After Intracoronary {gamma}-Radiation in Patients With In-Stent Restenosis

Washington Radiation for In-Stent Restenosis Trial Plus 6 Months of Clopidogrel (WRIST PLUS)

Ron Waksman, MD; Andrew E. Ajani, MD; R. Larry White, MD; Ellen Pinnow, MS; Regina Dieble, RN; Anh B. Bui, MD; Maeve Taaffe, RN; Luis Gruberg, MD; Gary S. Mintz, MD; Lowell F. Satler, MD; Augusto D. Pichard, MD; Kenneth K. Kent, MD; Joseph Lindsay, MD

From the Washington Hospital Center, Washington, DC.

Correspondence to Ron Waksman, MD, Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010. E-mail rxw8{at}mhg.edu

Background—Intracoronary {gamma}-radiation reduces recurrent in-stent restenosis. Late thrombosis (>30 days after radiation therapy) is identified as a serious complication. The Washington Radiation for In-Stent Restenosis Trial (WRIST) PLUS, which involved 6 months of treatment with clopidogrel and aspirin, was designed to examine the efficacy and safety of prolonged antiplatelet therapy for the prevention of late thrombosis.

Methods and Results—A total of 120 consecutive patients with diffuse in-stent restenosis in native coronary arteries and vein grafts with lesions <80 mm underwent percutaneous coronary transluminal angioplasty, laser ablation, and/or rotational atherectomy. Additional stents were placed in 34 patients (28.3%). After the intervention, a closed-end lumen catheter was introduced into the artery, a ribbon with different trains of radioactive 192Ir seeds was positioned to cover the treated site, and a dose of 14 Gy to 2 mm was prescribed. Patients were discharged with clopidogrel and aspirin for 6 months and followed angiographically and clinically. All patients but one tolerated the clopidogrel. The late occlusion and thrombosis rates were compared with the {gamma}-radiation–treated (n=125) and the placebo patients (n=126) from the WRIST and LONG WRIST studies (which involved only 1 month of antiplatelet therapy). At 6 months, the group receiving prolonged antiplatelet therapy had total occlusion and late thrombosis rates of 5.8% and 2.5%, respectively; these rates were lower than those in the active {gamma}-radiation group and similar to those in the placebo historical control group.

Conclusions—Six months of clopidogrel and aspirin and a reduction in re-stenting for patients with in-stent restenosis treated with {gamma}-radiation is well tolerated and associated with a reduction in the late thrombosis rate compared with a similar cohort treated with only 1 month of clopidogrel and aspirin.


Key Words: thrombosis • platelets • restenosis • stents • radiation




This article has been cited by other articles:


Home page
 J Am Coll CardiolHome page
American College of Cardiology Foundation, American Heart Association Task Force on Practice, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interve, Society for Vascular Medicine, Society for Vascular Surgery, L. A. Fleisher, et al.
2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery
J. Am. Coll. Cardiol., November 24, 2009; 54(22): e13 - e118.
[Full Text] [PDF]

Home page
 J Am Coll Cardiol IntvHome page
F. Sera, M. Awata, M. Uematsu, J.-i. Kotani, S. Nanto, and S. Nagata
Optimal Stent-Sizing With Intravascular Ultrasound Contributes to Complete Neointimal Coverage After Sirolimus-Eluting Stent Implantation Assessed by Angioscopy
J. Am. Coll. Cardiol. Intv., October 1, 2009; 2(10): 989 - 994.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al.
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery
J. Am. Coll. Cardiol., October 23, 2007; 50(17): e159 - e242.
[Full Text] [PDF]

Home page
 CirculationHome page
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al.
ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)
Circulation, October 23, 2007; 116(17): e418 - e500.
[Full Text] [PDF]

Home page
 CirculationHome page
E. Camenzind, P. G. Steg, and W. Wijns
A Cause for Concern
Circulation, March 20, 2007; 115(11): 1440 - 1455.
[Full Text] [PDF]

Home page
 CirculationHome page
P. W. Serruys and J. Daemen
Late Stent Thrombosis: A Nuisance in Both Bare Metal and Drug-Eluting Stents
Circulation, March 20, 2007; 115(11): 1433 - 1439.
[Full Text] [PDF]

Home page
 NEJMHome page
J. C.J. Sun, J. W. Eikelboom, P. Agostoni, G. M. Sangiorgi, G. G. Biondi-Zoccai, B. Scheller, M. Bohm, and E. Camenzind
Treatment of Restenosis with a Paclitaxel-Coated Balloon Catheter
N. Engl. J. Med., March 8, 2007; 356(10): 1071 - 1073.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
F. Liistro, M. Fineschi, P. Angioli, G. Sinicropi, G. Falsini, T. Gori, K. Ducci, A. Bravi, and L. Bolognese
Effectiveness and Safety of Sirolimus Stent Implantation for Coronary In-Stent Restenosis: The TRUE (Tuscany Registry of Sirolimus for Unselected In-Stent Restenosis) Registry
J. Am. Coll. Cardiol., July 18, 2006; 48(2): 270 - 275.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
J.-i. Kotani, M. Awata, S. Nanto, M. Uematsu, F. Oshima, H. Minamiguchi, G. S. Mintz, and S. Nagata
Incomplete Neointimal Coverage of Sirolimus-Eluting Stents: Angioscopic Findings
J. Am. Coll. Cardiol., May 16, 2006; 47(10): 2108 - 2111.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
P. K. Kuchulakanti, W. W. Chu, R. Torguson, P. Ohlmann, S.-W. Rha, L. C. Clavijo, S.-W. Kim, A. Bui, N. Gevorkian, Z. Xue, et al.
Correlates and Long-Term Outcomes of Angiographically Proven Stent Thrombosis With Sirolimus- and Paclitaxel-Eluting Stents
Circulation, February 28, 2006; 113(8): 1108 - 1113.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
G Sianos, A Hoye, F Saia, W van der Giessen, P Lemos, P J de Feyter, P C Levendag, R van Domburg, and P W Serruys
Long term outcome after intracoronary {beta} radiation therapy
Heart, July 1, 2005; 91(7): 942 - 947.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
R. M. Wolfram, A. C. Budinsky, B. Pokrajac, R. Potter, and E. Minar
Vascular Brachytherapy with 192Ir after Femoropopliteal Stent Implantation in High-Risk Patients: Twelve-month Follow-up Results from the Vienna-5 Trial
Radiology, July 1, 2005; 236(1): 343 - 351.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
P. W. Serruys, W. Wijns, G. Sianos, I. de Scheerder, P. A. van den Heuvel, W. Rutsch, H. D. Glogar, C. Macaya, P. H. Materne, S. Veldhof, et al.
Direct stenting versus direct stenting followed by centered beta-radiation with intravascular ultrasound-guided dosimetry and long-term anti-platelet treatment: Results of a randomized trial: Beta-radiation Investigation with Direct stenting and Galileo in Europe (BRIDGE)
J. Am. Coll. Cardiol., August 4, 2004; 44(3): 528 - 537.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
M. Togni, S. Windecker, P. Wenaweser, D. Tueller, A. Kaisaier, W. Maier, B. Meier, and O. M. Hess
Deleterious Effect of Coronary Brachytherapy on Vasomotor Response to Exercise
Circulation, July 13, 2004; 110(2): 135 - 140.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
R. Waksman, A. E. Ajani, R. L. White, R. Chan, B. Bass, A. D. Pichard, L. F. Satler, K. M. Kent, R. Torguson, R. Deible, et al.
Five-Year Follow-Up After Intracoronary Gamma Radiation Therapy for In-Stent Restenosis
Circulation, January 27, 2004; 109(3): 340 - 344.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
E. Cheneau, M. C. John, J. Fournadjiev, R. C. Chan, H.-S. Kim, L. Leborgne, R. Pakala, H. Yazdi, A. E. Ajani, R. Virmani, et al.
Time Course of Stent Endothelialization After Intravascular Radiation Therapy in Rabbit Iliac Arteries
Circulation, April 29, 2003; 107(16): 2153 - 2158.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
R. Waksman, E. Cheneau, A. E. Ajani, R. L. White, E. Pinnow, R. Torguson, R. Deible, L. F. Satler, A. D. Pichard, K. M. Kent, et al.
Intracoronary Radiation Therapy Improves the Clinical and Angiographic Outcomes of Diffuse In-Stent Restenotic Lesions: Results of the Washington Radiation for In-Stent Restenosis Trial for Long Lesions (Long WRIST) Studies
Circulation, April 8, 2003; 107(13): 1744 - 1749.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
P. Urban, P. Serruys, D. Baumgart, A. Colombo, S. Silber, E. Eeckhout, A. Gershlick, K. Wegscheider, L. Verhees, R. Bonan, et al.
A multicentre European registry of intraluminal coronary beta brachytherapy
Eur. Heart J., April 1, 2003; 24(7): 604 - 612.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. E. Ajani, R. Waksman, E. Cheneau, D.-H. Cha, S. McGlynn, M. Castagna, R. C. Chan, L. F. Satler, K. M. Kent, A. D. Pichard, et al.
The outcome of percutaneous coronary intervention in patients with In-Stentrestenosis who failed intracoronary radiation therapy
J. Am. Coll. Cardiol., February 19, 2003; 41(4): 551 - 556.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
R. Bonvini, I. Baumgartner, D. D. Do, M. Alerci, J.-M. Segatto, P. Tutta, K. Jager, M. Aschwanden, E. Schneider, B. Amann-Vesti, et al.
Late acute thrombotic occlusion after endovascular brachytherapy and stenting of femoropopliteal arteries
J. Am. Coll. Cardiol., February 5, 2003; 41(3): 409 - 412.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
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]

Home page
 Eur Heart JHome page
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]

Home page
 CirculationHome page
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]

Home page
 CirculationHome page
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]

Home page
 Eur Heart JHome page
C. di Mario and K. Toutouzas
No room for radiant dreams in the real world
Eur. Heart J., July 1, 2002; 23(13): 999 - 1001.
[Full Text] [PDF]

Home page
 NEJMHome page
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]

Home page
 J Am Coll CardiolHome page
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]

Home page
 CirculationHome page
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]

Home page
 Journal Watch CardiologyHome page
Longer Antiplatelet Therapy Beneficial After Brachytherapy
Journal Watch Cardiology, August 3, 2001; 2001(803): 7 - 7.
[Full Text]


Circulation Home | Subscriptions | Archives | Feedback | Authors | Help | AHA Journals Home | Search
Copyright © 2001 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.