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Endovascular gamma irradiation for the prevention restenosis after angioplasty of femoropopliteal de novo stenoses

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Abstract

The purpose of this study was to investigate the effectiveness and detect side effects of centered, overlapped endovascular gamma irradiation after angioplasty of de novo femoropopliteal stenoses. Thirty patients (age 65.3±9.2 years) with arterial occlusive disease were prospectively enrolled to receive endovascular gamma irradiation (192-iridium, 14 Gy centered at 2 mm vessel wall) immediately after percutaneous transluminal angioplasty (PTA) of femoropopliteal stenoses. Irradiation overlapped dilatation by 1–2 cm at each end. Follow-up involved angiography after 12 months; duplex sonography; and interviews before and after PTA and at 1, 6, and 12 months follow-up. PTA and centered endovascular irradiation were performed successfully in all patients. Three thromboembolic complications occurred during irradiation. Angiographic and clinical follow-up was possible in 28 patients. The angiographic degree of stenosis was 73.8%±16.3% before and 3.6%±23.5% after PTA and was 3.5%±43.7% at the 1-year follow-up. Restenosis (>50%) of the target lesion developed in three patients (10.7%) and edge stenoses (>30%) in nine patients (32.1%). An aneurysm of the irradiated segment in one patient was treated by stenting. The rate of retreatment was 17.9%. The vessel diameter after endovascular gamma irradiation and PTA of femoropopliteal stenoses remained stable. Restenosis, induction of edge stenoses, and aneurysm were reasons for reinterventions.

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References

  1. Johnston KW (1992) Femoral and popliteal arteries: reanalysis of results of balloon angioplasty. Radiology 183:767–771

    PubMed  Google Scholar 

  2. Minar E, Ahmadi A, Koppensteiner R, Maca T, Stumpflen A, Ugurluoglu A, Ehringer H (1995) Comparison of effects of high-dose and low-dose aspirin on restenosis after femoropopliteal percutaneous transluminal angioplasty. Circulation 91:2167–2173

    PubMed  Google Scholar 

  3. Minar E, Pokrajac B, Maca T, Ahmadi R, Fellner C, Mittlbock M, Seitz W, Wolfram R, Potter R (2000) Endovascular brachytherapy for prophylaxis of restenosis after femoropopliteal angioplasty: results of a prospective randomized study. Circulation 102:2694–2699

    PubMed  Google Scholar 

  4. Liermann DD, Bauernsachs R, Schopohl B, Bottcher HD (1997) Five year follow-up after brachytherapy for restenosis in peripheral arteries. Semin Interv Cardiol 2:133–137

    PubMed  Google Scholar 

  5. Pokrajac B, Schmid R, Poetter R, Wolfram R, Kirisits C, Mendl H, Kopp M, Minar E (2003) Endovascular brachytherapy prevents restenosis after femoropopliteal angioplasty: results of the Vienna-3 multicenter study. Int J Radiat Oncol Biol Phys 57:S250

    Article  Google Scholar 

  6. Krueger K, Zaehringer M, Bendel M, Stuetzer H, Strohe D, Nolte M, Wittig D, Mueller RP, Lackner K (2004) De novo femoropopliteal stenoses: endovascular gamma irradiation following angioplasty—angiographic and clinical follow-up in a prospective randomized controlled trial. Radiology 231:546–554

    PubMed  Google Scholar 

  7. Waksman R, Laird JR, Jurkovitz CT, Lansky AJ, Gerrits F, Kosinski AS, Murrah N, Weintraub WS (2001) Intravascular radiation therapy after balloon angioplasty of narrowed femoropopliteal arteries to prevent restenosis: results of the paris feasibility clinical trial. J Vasc Interv Radiol 12:915–921

    PubMed  Google Scholar 

  8. Zehnder T, von Briel C, Baumgartner I, Triller J, Greiner R, Mahler F, Do DD (2003) Endovascular brachytherapy after percutaneous transluminal angioplasty of recurrent femoropopliteal obstructions. J Endovasc Ther 10:304–311

    Article  PubMed  Google Scholar 

  9. Sabate M, Costa MA, Kozuma K, Kay IP, van der Giessen WJ, Coen VL, Ligthart JM, Serrano P, Levendag PC, Serruys PW (2000) Geographic miss: a cause of treatment failure in radio-oncology applied to intracoronary radiation therapy. Circulation 101:2467–2471

    PubMed  Google Scholar 

  10. Waksman R, White RL, Chan RC, Bass BG, Geirlach L, Mintz GS, Satler LF, Mehran R, Serruys PW, Lansky AJ, Fitzgerald P, Bhargava B, Kent KM, Pichard AD, Leon MB (2000) Intracoronary gamma-radiation therapy after angioplasty inhibits recurrence in patients with in-stent restenosis. Circulation 101:2165–2171

    PubMed  Google Scholar 

  11. Albiero R, Nishida T, Adamian M, Amato A, Vaghetti M, Corvaja N, Di Mario C, Colombo A (2000) Edge restenosis after implantation of high activity (32)P radioactive beta-emitting stents. Circulation 101:2454–2457

    PubMed  Google Scholar 

  12. Sabate M, Serruys PW, van der Giessen WJ, Ligthart JM, Coen VL, Kay IP, Gijzel AL, Wardeh AJ, den Boer A, Levendag PC (1999) Geometric vascular remodeling after balloon angioplasty and beta-radiation therapy: a three-dimensional intravascular ultrasound study. Circulation 100:1182–1188

    PubMed  Google Scholar 

  13. Leon MB, Teirstein PS, Lansky AJ (1999) Intracoronary gamma radiation to reduce in-stent restenosis: the multicenter GAMMA I randomized clinical trial. J Am Coll Cardiol 33:56A

    Google Scholar 

  14. Williams DM, Fencil L, Chenevert TL (1990) Peripheral arterial occlusive disease: P-31 MR spectroscopy of calf muscle. Radiology 175:381–385

    PubMed  Google Scholar 

  15. Pokrajac B, Potter R, Maca T, Fellner C, Mittlbock M, Ahmadi R, Seitz W, Minar E (2000) Intraarterial (192)Ir high-dose-rate brachytherapy for prophylaxis of restenosis after femoropopliteal percutaneous transluminal angioplasty: the prospective randomized Vienna-2-trial radiotherapy parameters and risk factors analysis. Int J Radiat Oncol Biol Phys 48:923–931

    Article  PubMed  Google Scholar 

  16. Krueger K, Bendel M, Zaehringer M, Weise C, Lackner K (2002) Experimental and clinical evaluation of the PARIS centering catheter for delivery of endovascular gamma-irradiation of femoropopliteal stenoses. Cardiovasc Radiat Med 2:213–219

    Article  Google Scholar 

  17. Kruger K, Bendel M, Zahringer M, Bongartz R, Nolte M, Schulte O, Lackner K (2002) Endovascular gamma-irradiation for prevention or restenosis after angioplasty of femoropopliteal de-novo-stenoses-long-term results of a feasibility study. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 174:321–327

    Article  PubMed  Google Scholar 

  18. Krepel VM, van Andel GJ, van Erp WF, Breslau PJ (1985) Percutaneous transluminal angioplasty of the femoropopliteal artery: initial and long-term results. Radiology 156:325–328

    PubMed  Google Scholar 

  19. Raizner AE, Kaluza GL, Ali NM (1999) Clinical experience with a spiral balloon centering catheter for the delivery of intracoronary radiation therapy. Cardiovasc Radiat Med 1:214–219

    Article  PubMed  Google Scholar 

  20. Fritz P, Stein U, Hasslacher C, Zierhut D, Wannenmacher M, Pritsch M (2004) External beam radiotherapy fails to prevent restenosis after iliac or femoropopliteal percutaneous transluminal angioplasty: results of a prospective randomized double-blind study. Int J Radiat Oncol Biol Phys 59:815–821

    Article  PubMed  Google Scholar 

  21. Hoher M, Wohrle J, Wohlfrom M, Hanke H, Voisard R, Osterhues HH, Kochs M, Reske SN, Hombach V, Kotzerke J (2000) Intracoronary beta-irradiation with a liquid (188)re-filled balloon: six-month results from a clinical safety and feasibility study. Circulation 101:2355–2360

    PubMed  Google Scholar 

  22. Lansky AJ, Popma JJ, Massullo V, Jani S, Russo RJ, Schatz RA, Steuterman S, Guarneri EM, Wu H, Mehran R, Mintz GS, Leon MB, Teirstein PS (1999) Quantitative angiographic analysis of stent restenosis in the Scripps Coronary Radiation to Inhibit Intimal Proliferation Post Stenting (SCRIPPS) Trial. Am J Cardiol 84:410–414

    Article  PubMed  Google Scholar 

  23. Hagenaars T, A Po IF, van Sambeek MR, Coen VL, Van Tongeren RB, Gescher FM, Wittens CH, Boelhouwer RU, Pattynama PM, Gussenhoven EJ (2002) Gamma radiation induces positive vascular remodeling after balloon angioplasty: a prospective, randomized intravascular ultrasound scan study. J Vasc Surg 36:318–324

    PubMed  Google Scholar 

  24. Costa MA, Sabat M, van der Giessen WJ ,Kay IP, Cervinka P, Ligthart JM, Serrano P, Coen VL, Levendag PC, Serruys PW (1999) Late coronary occlusion after intracoronary brachytherapy. Circulation 100:789–792

    PubMed  Google Scholar 

  25. Waksman R, Bhargava B, Leon MB (2000) Late thrombosis following intracoronary brachytherapy. Catheter Cardiovasc Interv 49:344–347

    Article  PubMed  Google Scholar 

  26. Waksman R, Bhargava B, Mintz GS, Mehran R, Lansky AJ, Satler LF, Pichard AD, Kent KM, Leon MB (2000) Late total occlusion after intracoronary brachytherapy for patients with in-stent restenosis. J Am Coll Cardiol 36:65–68

    Article  PubMed  Google Scholar 

  27. Waksman R (1999) Late thrombosis after radiation. Sitting on a time bomb. Circulation 100:780–782

    PubMed  Google Scholar 

  28. Schillinger M, Mlekusch W, Wolfram RM, Budinsky AC, Exner M, Rumpold H, Wagner O, Pokrajac B, Potter R, Minar E (2004) Endovascular brachytherapy: effect on acute inflammatory response after percutaneous femoropopliteal arterial interventions. Radiology 230:556–560

    PubMed  Google Scholar 

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Correspondence to Karsten Krueger.

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Krueger, K., Bendel, M., Zaehringer, M. et al. Endovascular gamma irradiation for the prevention restenosis after angioplasty of femoropopliteal de novo stenoses. Eur Radiol 16, 399–406 (2006). https://doi.org/10.1007/s00330-005-2883-x

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  • DOI: https://doi.org/10.1007/s00330-005-2883-x

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