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Clinical Investigations: CARDIOLOGY |

Intracoronary β-Irradiation With Liquid Rhenium-188*: Results of the Taiwan Radiation in Prevention of Post-Pure Balloon Angioplasty Restenosis Study

Chi-Ling Hang; Morgan Fu; Bor-Tsung Hsieh; Stephen Wan Leung; Chiung-Jen Wu; Hon-Kan Yip; Gann Ting
Author and Funding Information

*From the Section of Cardiology (Drs. Hang, Fu, Wu, and Yip), Department of Internal Medicine, and Department of Radiation Oncology (Dr. Leung), Chang Gung Memorial Hospital, Kaohsiung Hsien, Taiwan, Republic of China; Institute of Nuclear Energy Research (Drs. Hsieh and Ting), Taoyuan Hsien, Taiwan, Republic of China.

Correspondence to: Stephen Wan Leung, MD, Chang Gung Memorial Hospital, 123 Ta-Pei Rd, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan, Republic of China



Chest. 2003;124(4):1284-1293. doi:10.1378/chest.124.4.1284
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Study objective: To assess the feasibility and short-term outcome of intracoronary irradiation after pure balloon angioplasty (POBA) of de novo and post-POBA restenotic lesions with a liquid β-emitter 188Re-filled balloon.

Design and setting: Nonrandomized prospective study with contemporaneous control group in a single medical center.

Patients and methods: In the Taiwan Radiation in Prevention of Post-Pure Balloon Angioplasty Restenosis study, 40 patients underwent 14-Gy irradiation and 15 patients underwent 20-Gy irradiation at a tissue depth of 0.5 mm after POBA. Thirty control patients received a 5-min inflation with a perfusion balloon catheter after POBA.

Results: No procedural or in-hospital complications, or 30-day major adverse cardiac events were noted. Six-month angiographic restenosis rates were 49% in the 14-Gy group, 20% in the 20-Gy group, and 57% in the control group (p = 0.05, 20-Gy group vs control group). In the lesions with an arc of calcification of < 180°, restenosis occurred in 15 of the 34 lesions (44%) in the 14-Gy group and in none of the 11 lesions (0%) in the 20-Gy group (p = 0.007). In a vessel with a reference diameter < 3.0 mm, restenosis occurred in 1 of the 8 lesions (13%) in the 20-Gy group, and in 8 of the 11 lesions (73%) in the control group (p = 0.02). In the post-POBA restenotic lesions, restenosis occurred in none of the six lesions (0%) in the 20-Gy group, and in five of the six lesions (83%) in the control group (p = 0.008).

Conclusions: Post-POBA, catheter-based brachytherapy in nonstented native coronary artery with a 188Re-filled balloon can effectively reduce target lesion restenosis with 20-Gy irradiation at a tissue depth of 0.5 mm and seems to be more effective in the treatment of lesions with an arc of calcification < 180°, in a vessel with a reference diameter of < 3.0 mm, and in post-POBA restenotic lesions.

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