^(192)Ir射线治疗老年冠脉支架内再狭窄的机制和1年临床随访:系列血管内超声分析

Mechanism and efficacy of intracoronary ^(192)Ir radiotherapy in old patients with in-stent restenosis: a serial intravascular ultrasound study and one-year clinical follow-up

目的 探讨1 92 Ir对老年冠心病支架内再狭窄的 1年的临床疗效及机制。方法 99例老年冠心病支架内再狭窄病人经常规介入治疗后随机分为1 92 Ir治疗组和安慰剂组 ,在放疗后即刻和 6个月行血管内超声检查 ,分别测量支架、管腔及增生内膜的内径和面积 ,并临床随访 1年 ,对所得参数进行统计学处理。结果 99例病人中 ,糖尿病 3 9.4%,有支架内再狭窄史 5 8.6%,弥漫性病变 68%,静脉桥病变 18.5 %;两组治疗前后及两组间支架内径和面积无显著性变化 ,两组间放疗后即刻各参数也无显著性变化。随访中 ,治疗组和安慰剂组的最小腔内径、最小腔内面积和平均腔内面积分别为 :2 .0 3± 0 .47与 1.5 9± 0 .65mm ,P <0 .0 0 1;4.3 0± 2 .0 0与 2 .81± 2 .5 6mm2 ,P =0 .0 0 6;6.47± 2 .5 3与 5 .0 3± 3 .82mm2 ,P =0 .0 94。治疗组与对照组平均新生内膜和新生内膜百分比分别为 2 .2 2± 1.2 6与 3 .3 7± 1.89,P =0 .0 11;3 5± 17%与 5 7± 2 3 %,P <0 .0 0 1。 6个月的再狭窄率 ,治疗组与对照组分别为 :2 4.71%与 78.6%,p <0 .0 1。临床随访 1年 ,治疗组与对照组主要的心脏事件、靶血管及靶病变再介入治疗分别为 73 .0 %与 48.6%,P =0 .0 2 7;2 3 .8%与 5 1.4%,P =0 .0 0 6;11.6%与 40 .97%,P =0 .0 0 7。结论?

Objective Using intravascular ultrasound (IVUS), we studied mechanism and one-year clinical follow-up efficacy of intracoronary 192 Ir radiation therapy in old patients with in-stent restenosis.Methods 99 patients with in-stent restenosis were first treated with conventional techniques and then randomized (blinded) to receive either gamma radiation ( 192 Ir) or a placebo. IVUS studied with motorized to pullback (0.5mm/s) were performed immediately after irradiation and at 6-month follow-up in patients. Serial stent, lumen and intimal hyperplasia(IH) (stent-lumen) were measured (using IVUS) every 1mm within the stent. Clinical follow-up was performed at one year.Results Baseline clinical, vessel location and conventional techniques were similar in both groups. Baseline IVUS variables were similar in both groups. Minimal stent area and mean stent area were similar at postirradiation and follow-up in both groups. However, the decrease in minimal lumen area and the increase in mean IH area and IH% was less in 192 Ir patients compared with placebo patients. Binary angiograpgic restenosis was less in the 192 Ir group (24.71% versus 78.6% for placebo group,p<0.01. At one-year follow-up, MACE ,TVR and TLR were lower in 192 Ir group compared with placebo group, 27% versus 51.4%, 23.8% versus 51.4% and 11.6% versus 40.9%, respectively.Conclusions By inhibiting intimal hyperplasia within the stent, gamma radiotherapy with 192 Ir source is effective in reducing the recurrence of in-stent restenosis and improving one-year clinical outcome in the elderly.