冠状动脉内放射治疗对支架内再狭窄的作用

The effect of intracoronary brachytherapy after coronary angioplasty on in stent restenosis

目的 研究应用β射线 (90 Sr/90 y)进行冠状动脉内放射治疗对国人支架内再狭窄的作用。方法 自 1 999年 1 2月至 2 0 0 2年 1月 ,我院对 5 3例患者 [男 4 9例 ,女 4例 ,平均年龄 (5 3 2± 9 8)岁 ]5 5处支架内再狭窄病变 (支架直径≥ 2 5mm ,1 0mm≤病变长度≤ 30mm) ,在球囊 (1 0处病变用普通球囊 ,4 5处病变用切割球囊 )满意扩张后 ,应用Beta Cath系统 (Novoste)进行冠状动脉内放射治疗。放射源长度 4 0mm。术后 8个月随访冠状动脉造影 ,用MEDCONViewer软件包进行定量冠状动脉造影 (QCA)分析。结果 5 3例患者 5 5处支架内再狭窄病变均被满意扩张 ,冠状动脉内放射治疗全部成功 ,术中并发冠状动脉痉挛 1例 (1 8%) ,无其他并发症。全部患者随访期中无死亡 ,随访≥ 8个月 33例患者中 1例 (3 0 %)发生非Q波心肌梗死 ,6例 (1 8 2 %)进行靶血管重建术。该 33例患者中 2 9例(87 9%) 30处病变进行了随访冠状动脉造影 ,再狭窄率在支架段为 1 0 0 %(3/30 ) ,分析段为 2 3 3 %(7/30 )。最小管径直径术前为 (0 41± 0 2 2 )mm ,术后即刻为 (1 99± 0 42 )mm ,8个月随访时为 (1 73± 0 82 )mm ,平均病变长度为 (2 3 3± 5 4)mm。全部患者无晚期血栓形成、假性动脉瘤及冠状动脉瘤发生。结论 应用90

Objective To evaluate the effect of intracoronary brachytherapy using 90 Sr/ 90 y after balloon angioplasty on in stent restenosis in Chinese patients Methods Fifty five lesions with in stent restenosis (stent diameter ≥2 5 mm, 10 mm ≤ lesion length ≤30 mm) in 53 patients, male 49, female 4, with mean age of (53 2±9 8) years, were treated using Beta Cath system (Novoste) with 40 mm of source train after balloon angioplasty, using regular balloon in 10 lesions and cutting balloon in 45 lesions, in this institution from December 1999 to January 2002 Follow up angiography was performed after 8 months of brachytherapy Quantitative coronary angiography (QCA) was performed by MEDCON Viewer QCA software package Results The procedure of balloon angioplasty followed by brachytherapy were successful in all 55 lesions (100%) Refractory coronary spasm developed in 1 (1 8%) case No other complications occurred During follow up period no death occurred Among the 33 cases who were followed more than 8 months non Q myocardial infarction developed in 1 (3 0%) patients, target vessel revascularization in 6 (18 2%) cases Follow up angiography was performed in 30 lesions of the 29 (87 9%) cases, which revealed that binary restenosis, defined as diameter stenosis ≥50%, was 10 0% (3/30) in stent segments and 23 3% (7/30) in analysis segments The mininum luminal diameter was (0 41±0 22) mm before angioplasty, (1 99±0 42) mm immediately after angioplasty and (1 73±0 82) mm at 8 months follow up The mean lesion length was (23 3±5 4) mm No coronary aneurysm and pseudoaneurysm were detected during follow up angiography Conclusion The brachytherapy using 90 Sr/ 90 y after balloon angioplasty is safe and feasible for in stent restenosis in Chinese patients In this group of patients the restenosis rate is similar to that reported in large scale clinical trials The results suggest that brachytherapy should be performed if the lesion length of in stent restenosis was longer than 10 mm