Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
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Brachytherapy in Coronary Artery Disease

관상동맥질환의 방사성동위원소 치료

  • Song, Ho-Chun (Department of Nuclear Medicine, Chonnam National University Medical School)
  • 송호천 (전남대학교 의과대학 핵의학교실)
  • Published : 2006.04.29
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Abstract

Coronary artery disease is a loading cause of morbidity and mortality across the world. Percutaneous coronary intervention has become the major technique of revascularization. However, restenosis remains a major limitation of this procedure. Recently the need for repeat intervention due to restenosis, the most vexing long-term failure of percutaneous coronary intervention, has been significantly reduced owing to the introduction of two major advances, intracoronary brachytherapy and the drug-eluting stents. Intracoronary brachytherapy has been employed in recent years to prevent restenosis lesions with effective results, principally in in-stent restenosis. Restenosis is generally considered as au excessive form of normal wound healing divided up in precesses: elastic recoil, neointimal hyperplasia, and negative vascular remodeling. Restenosis has previously been regarded as a proliferative process in which neointimal thickening, mediated by a cascade of inflammatory mediators and other factors, is the key factor. Ionizing radiation has been shown to decrease the proliferative response to injury in animal models of restenosis. Subsequently, several randomized, double blind trials have demonstrated that intracoronary brachytherapy can reduce the rates of both angiographic restenosis and clinical event rates in patients undergoing percutaneous coronary intervention for in stent restenosis. Some problems, such as late thrombosis and edge restenosis, have been identified as limiting factors of this technique. Brachytherapy is a promising method of preventing and treating coronary artery restenosis.

Keywords

References

  1. Arjomand H, Turi ZG, McCormick D, Goldberg S. Percutaneous coronary intervention: historical perspectives, current status, and future directions. Am Heart J 2003;146:787-96 https://doi.org/10.1016/S0002-8703(03)00153-4
  2. Giedd KN, Bergmann SR. Myocardial perfusion imaging following percutaneous coronary intervention: theimportance of restenosis, disease progression, and directed reintervention.J Am Coll Cardiol 2004;43:328-36 https://doi.org/10.1016/j.jacc.2003.09.032
  3. Kaluza GL, Raizner AE. Brachytherapy for restenosis after stenting for coronary artery disease: itsrole in the drug-eluting stent era. Curr Opin Cardiol 2004;19:601-7 https://doi.org/10.1097/01.hco.0000142069.39957.03
  4. Beyar R. Novel approaches to reduce restenosis. Ann N Y Acad Sci 2004;1015:367-78 https://doi.org/10.1196/annals.1302.032
  5. Haude M, Erbel R, Issa H, Meyer J. Quantitative analysis of elastic recoil after balloon angioplasty and after intracoronary implantation of balloon-expandable Palmaz-Schatz stents. J Am Coll Cardiol 1993;2126-34
  6. Garratt KN, Holmes DR, Bell MR, Bresnahan JF, Kaufmann UP, Vlietstra RF, et al. Restenosis after directional coronary atherectomy: differences between primary atheromatous and restenosis lesions and influences of subintimal tissue resection. J Am Coll Cardiol 1990;16:1665-71 https://doi.org/10.1016/0735-1097(90)90317-I
  7. Mintz GS, Kent KM, Pichard AD, Popma JJ, Satler LF, Leon MB. Intravascular ultrasound insights into mechanisms of stenosis formation andrestenosis. Cardiol Clin 1997;15:17-29 https://doi.org/10.1016/S0733-8651(05)70315-5
  8. Schwartz RS, Murphy JG, Edwards WD, Camrud AR, Vlietstra RE, Holmes DR. Restenosis after balloon angioplasty: a practical proliferative model in porcine coronary aterries. Circulation 1990;82:2190-200 https://doi.org/10.1161/01.CIR.82.6.2190
  9. Hojo Y, Ikeda U, Katsuki T, Mizuno O, Fukazawa H, Kurosaki K, et al. Interleukin 6 expression in coronary circulation after coronary angioplasty as a risk factor for restenosis. Heart 2000;84:83-7 https://doi.org/10.1136/heart.84.1.83
  10. Rubin P, Williams JP, Riggs PN, Bartos S, Sarac T, Pomerantz R, et al. Cellular and molecular mechanisms of radiation inhibition of restenosis. PartI: role of the macrophage and platelet-derived growth factor. Int J Radiat Oncol Biol Phys 1998;40:929-41 https://doi.org/10.1016/S0360-3016(97)00937-1
  11. Sarac TP, Riggs PN, Williams JP, Feins RH, Baggs R, Rubin P, et al The effects of low-dose radiation on neointimal hyperplasia. J Vasc Surg 1995;22:17-24 https://doi.org/10.1016/S0741-5214(95)70083-8
  12. Metzdorff MT. Intracoronary radiotherapy for restenosis. N Engl J Med 2001;344:1796-7 https://doi.org/10.1056/NEJM200106073442314
  13. Del Negro A. Bringing vascular brachytherapy to the US forefront: FDA approves two radiation systems for in-stent restenosis. Cardiovasc Radiat Med 2001;2:119-23 https://doi.org/10.1016/S1522-1865(00)00089-5
  14. SoRelle R. Two intravascular brachytherapy systems approved by FDA. Circulation 2000;102:E9041-3 https://doi.org/10.1161/01.CIR.102.21.e9041
  15. Sapirstein W, Zuckerman B, Dillard J. FDA approval of coronary-artery brachytherapy. N Engl J Med 2001;344:297-9 https://doi.org/10.1056/NEJM200101253440410
  16. Albiero R, Nishida T, Adamian M, Amato A, Vaghetti M, Corvaja N, et al. Edge restenosis after implantation of high activity (32)P radioactive beta-emitting stents. Circulation 2000;101:2454-7 https://doi.org/10.1161/01.CIR.101.21.2454
  17. Lee DC, Jeong MH, Kim KH, Bom HS, Hong YD, Park KB, et al. The effects of $^{166}$Ho-loaded radioactive stent in a porcine model. Korean Circ J 2002;32:479-84 https://doi.org/10.4070/kcj.2002.32.6.479
  18. Reynen K, Kockeritz U, Kropp J, Wunderlich G, Knapp FF, Schmeisser A, et al. Intracoronary radiotherapy with a (188)rhenium liquid-filled PTCA balloon system in in-stent restenosis: acute and long-term angiographic results, as well as 1-year clinical follow-up. Int J Cardiol 2004;95:29-34 https://doi.org/10.1016/j.ijcard.2003.03.004
  19. Park S, Kang WC, Rhee JH, Ko YG, Choi D, Jang Y, et al. Intracoronary $^{166}$Holmium brachytherapy combined with cutting balloon angioplasty for the treatment of in-stent restenosis. Cardiovasc Radiat Med 2003;4:119-25 https://doi.org/10.1016/S1522-1865(03)00181-1
  20. Apple M, Waksman R, Chan RC, Vodovotz Y, Fournadjiev J, Bass BG. Radioactive 133-Xenon gas-filled balloon to prevent restenosis: dosimetry, efficacy, and safety considerations. Circulation 2002;106:725-9 https://doi.org/10.1161/01.CIR.0000023945.21317.27
  21. Kim W, Jeong MH, Park OY, Rhew JY, Bom HS, Choi SJ, et al. Effects of beta-radiation using a holmium-166 coated balloon on neointimal hyperplasia in a porcine coronary stent restenosis model. Circ J 2003;67:625-9 https://doi.org/10.1253/circj.67.625
  22. Teirstein PS, Massullo V, Jani S, Popma JJ, Mintz GS, Russo RJ, et al. Catheter-based radiotherapy to inhibit restenosis after coronary stenting. N Engl J Med 1997;336:1697-703 https://doi.org/10.1056/NEJM199706123362402
  23. Teirstein PS, Massullo V, Jani S, Popma JJ, Russo RJ, Schatz RA, et al. Three-year clinical and angiographic follow-up after intracoronary radiation: results of a randomized clinical trial. Circulation 2000;101:360-5 https://doi.org/10.1161/01.CIR.101.4.360
  24. Grise MA, Massullo V, Jani S, Popma JJ, Russo RJ, Schatz RA, et al. Five-year clinical follow-up after intracoronary radiation: results of a randomized clinical trial. Circulation 2002;105:2737-40 https://doi.org/10.1161/01.CIR.0000018126.87045.E0
  25. Waksman R, White LR, Chan RC, Bass BG, Geirlach L, Mintz GS, et al. Intracoronary gamma-radiation therapy after angioplasty inhibits recurrence in patients with in-stent restenosis. Circulation 2000;101:2165-71 https://doi.org/10.1161/01.CIR.101.18.2165
  26. Waksman R, Cheneau E, Ajani AE, White RL, Pinnow E, Torguson R, et al. Intracoronary radiation therapy improves the clinical and angiographic outcomesof diffuse in-stent restenotic lesions: results of the Washington Radiation for In-Stent Restenosis Trial for Long Lesions (Long WRIST) Studies. Circulation 2003;107:1744-9 https://doi.org/10.1161/01.CIR.0000060497.91775.6D
  27. Raizner AE, Oesterle SN, Waksman R, Serruys PW, Colombo A, Lim YL, et al. Inhibition of restenosis with beta-emitting radiotherapy: Report of the Proliferation Reduction with Vascular Energy Trial (PREVENT). Circulation 2000;102:951-8 https://doi.org/10.1161/01.CIR.102.9.951
  28. Leon MB, Teirstein PS, Moses JW, Tripuraneni P, Lansky AJ, Jani S, et al. Localized intracoronary-radiation therapy to inhibit the recurrence of restenosis after stenting. N Engl J Med 2001;344:250-6 https://doi.org/10.1056/NEJM200101253440402
  29. Popma JJ, Suntharalingam M, Lansky AJ, Heuser RR, Speiser B, Teirstein PS, et al. Randomized trial of $^{90}$Sr/$^{90}$Y beta-radiation versus placebo control for treatment of in-stent restenosis. Circulation 2002;106:1090-6 https://doi.org/10.1161/01.CIR.0000027814.96651.72
  30. Silber S, Popma JJ, Suntharalingam M, Lansky AJ, Heuser RR, Speiser B, et al. Two-year clinical follow-up of $^{90}$Sr/$^{90}$Y beta-radiation versus placebo control for the treatment of in-stent restenosis. Am Heart J 2005;149:689-94 https://doi.org/10.1016/j.ahj.2004.05.061
  31. Waksman R, Raizner AE, Yeung AC, Lansky AJ, Vandertie L. Use of localised intracoronary beta radiation in treatment of in-stent restenosis. Lancet 2002;359:551-7 https://doi.org/10.1016/S0140-6736(02)07741-3
  32. Waksman R, Ajani AE, White RL, Chan RC, Satler LF, Kent KM, et al. Intravascular gamma radiation for in-stent restenosis in saphenous-vein bypass grafts. N Engl J Med 2002;346:1194-9 https://doi.org/10.1056/NEJMoa012579
  33. Kim KI, Bae J, Kang HJ, Koo BK, Youn TJ, Kim SH, et al. Three-year clinical follow-up results of intracoronary radiation therapy using a rhenium-188-diethylene-triamine-penta-acetic-acid- filled balloon system. Circ J 2004;68:532-7 https://doi.org/10.1253/circj.68.532
  34. Waksman R, Bhargava B, White L, Chan RC, Mehran R, Lansky AJ, et al. Intracoronary $\beta$-radiation therapy inhibits recurrences of in-stent restenosis. Circulation 2000;101:1895-8 https://doi.org/10.1161/01.CIR.101.16.1895
  35. King SB 3rd, Williams DO, Chougule P, Klein JL, Waksman R, Hilstead R, et al. Endovascular beta-radiation to reduce restenosis after coronary balloon angioplasty: results of the beta energy restenosis trial (BERT). Circulation 1998;97:2025-30 https://doi.org/10.1161/01.CIR.97.20.2025
  36. Hoher M, Wohrle J, Wohlfrom M, Hanke H, Voisard R, Osterhues HH, et al. Intracoronary beta-irradiation with a liquid (188)re-filled balloon: six-month results from a clinical safety and feasibility study. Circulation 2000;101:2355-60 https://doi.org/10.1161/01.CIR.101.20.2355
  37. Condado JA, Waksman R, Gurdiel O, Espinosa R, Gonzalez J, Burger B, et al. Long-term angiographic and clinical outcome after percutaneous transluminal coronary angioplasty and intracoronary radiation therapy in humans. Circulation 1997;96:727-32 https://doi.org/10.1161/01.CIR.96.3.727
  38. Verin V, Urban P, Popowski Y, Schwager M, Nouet P, Dorsaz PA, et al. Feasibility of intracoronary beta-irradiation to reduce restenosis after balloon angioplasty. A clinical pilot study. Circulation 1997;95:1138-44 https://doi.org/10.1161/01.CIR.95.5.1138
  39. Albiero R, Adamian M, Kobayashi N, Amato A, Vaghetti M, Di Mario C, et al. Short- and intermediate-term results of (32)P radioactive beta-emitting stent implantation in patients with coronary artery disease: The Milan Dose-Response Study. Circulation 2000;101:18-26 https://doi.org/10.1161/01.CIR.101.1.18
  40. Wardeh AJ, Kay IP, Sabate M, Coen VL, Gijzel AL, Ligthart JM, et al. Beta-Particle-emitting radioactive stent implantation. A safety and feasibility study. Circulation 1999;100:1684-9 https://doi.org/10.1161/01.CIR.100.16.1684
  41. Jo SH, Kim KI, Koo BK, Lee MM, Park SJ, Seo JB, et al. Long-Term Follow-Up Results of Intracoronary Beta-Radiation Therapy with a Rhenium-188 Diethylene Triamine Penta-Acetic Acid-Filled Balloon. Korean Circulation J 2003;33:723-9 https://doi.org/10.4070/kcj.2003.33.8.723
  42. Bae JW, Kang HJ, Kim KI, Cho YS, Youn TJ, Koo BK, rt al. Long-Term Effect of Repeated Brachytherapy in Intracoronary Brachytherapy Failed Lesions. Korean Circulation J 2004;34:937-44 https://doi.org/10.4070/kcj.2004.34.10.937
  43. Oh SJ, Park SW, Hong MK, Kim YH, Lee SW, Kim MK, et al. Long-Term Outcomes after Treatment of Diffuse In-Stent Restenosis with Rotational Atherectomy Followed by Beta-Radiation Therapy with a $^{188}$Re-$MAG_{3}$-Filled Balloon. Korean Circulation J 2004;34:930-6 https://doi.org/10.4070/kcj.2004.34.10.930
  44. Park SW, Kim JH, Choi SC, Hong MK, Moon DH, Oh SJ, et al. Treatment of Diffuse In-stent Restenosis with Rotational Atherectomy Followed by Radiation Therapy with a $^{188}$Re-$MAG_{3}$-Filled Balloon. Korean Circulation J 2001;31:466-75 https://doi.org/10.4070/kcj.2001.31.5.466
  45. Lee BK, Hong MK, Lee MJ, Kim DS, Lee SW, Park CB, et al. Late Intravascular Ultrasound Findings of Patients Treated with Brachytherapy for Diffuse In-Stent Restenosis. Korean Circulation J 2004;34:856-64 https://doi.org/10.4070/kcj.2004.34.9.856
  46. Kim SH, Kim HM, Cha KS, Choi DH, Ko YG, Gwon HC, et al. Effect of Vascular BRAchytherapy using HolmiuM-166 Liquid Balloon System after Cutting Balloon Angioplasty in Patients with Stent Restenosis (BRAHMS Study). Korean Circulation J 2005;35:591-6 https://doi.org/10.4070/kcj.2005.35.8.591
  47. Holmes DR Jr, Teirstein P, Satler L, Sketch M, O'Malley J, Popma JJ, et al. Sirolimus-eluting stents vs vascular brachytherapy for in-stent restenosis within bare-metal stents: the SISR randomized trial. JAMA 2006;295:1264-73 https://doi.org/10.1001/jama.295.11.1264
  48. Stone GW, Ellis SG, O'Shaughnessy CD, Martin SL, Satler L, McGarry T, et al. Paclitaxel-eluting stents vs vascular brachytherapy for in-stent restenosis within bare-metal stents: the TAXUS V ISR randomized trial. JAMA 2006;295:1253-63 https://doi.org/10.1001/jama.295.11.1253
  49. Mukherjee D, Moliterno DJ. Brachytherapy for in-stent restenosis: a distant second choice to drug-eluting stent placement. JAMA 2006;295:1307-9 https://doi.org/10.1001/jama.295.11.1307
  50. Waksman R, Bhargava B, Mintz GS, Mehran R, Lansky AJ, Satler LF, et al. Late total occlusion after intracoronary brachytherapy for patients with in-stent restenosis. J Am Coll Cardiol 2000;36:65-8 https://doi.org/10.1016/S0735-1097(00)00681-1
  51. Waksman R, Ajani AE, White RL, Pinnow E, Dieble R, Bui AB, et al. 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). Circulation 2001;103:2332-5 https://doi.org/10.1161/01.CIR.103.19.2332
  52. Weinberger J, Amols H, Ennis RD, Schwartz A, Wiedermann JG, Marboe C. Intracoronary irradiation: dose response for the prevention of restenosis in swine. Int J Radiat Oncol Biol Phys 1996;36:767-75 https://doi.org/10.1016/S0360-3016(96)00294-5
  53. Sabate M, Costa MA, Kozuma K, Kay IP, van der Giessen WJ, Coen VL, et al. Geographic miss: a cause of treatment failure in radiooncology applied to intracoronary radiation therapy. Circulation 2000;101:2467-71 https://doi.org/10.1161/01.CIR.101.21.2467