Effects of delayed (24 h postintervention) β-irradiation therapy after coronary angioplasty and stenting in de novo native coronary artery lesions

Abstract

Background

The effects of brachytherapy performed 24 h postintervention in de novo native coronary artery lesions.

Methods and Results

Thirty-nine patients with 39 de novo coronary artery lesions were randomised to prompt (immediately after intervention, n=21) or delayed (24 h later, n=18) beta brachytherapy (⁹⁰Sr/⁹⁰Y) after been successfully revascularized with stenting. Clinical follow-up data up to 21 months (median time) were compared. After irradiation and at 6-month follow-up, paired volumetric analysis of the stented segment and the 5-mm proximal and distal reference segments was performed; this included measurements of the external elastic membrane, lumen, plaque, and media (external elastic membrane minus lumen), stent and intima hyperplasia (stent minus lumen).

Baseline clinical and angiographic characteristics were similar in the two groups. Postintervention measurements of stent, lumen, and intima hyperplasia volumes as well as postintervention minimum lumen cross-sectional areas were not different. In the stented segments and in the segments 5 mm proximal and distal to the stent, similar changes of all IVUS measurements were measured in the two patient groups, but in the lumen volume at the proximal stent edge of patients irradiated 24 h postinjury. At 21 months median follow-up time, target lesion revascularization (TLR) was performed in 8 patients (38%) in the prompt irradiation group compared with 3 (17%) in the delayed (P=.17).

Conclusion

Beta irradiation is similarly effective whether performed immediately after percutaneous coronary intervention or 24 h later.