Dosimetrische Grundlagen für die endo vaskuläre Therapie mit Re-188 zur Prävention der Restenose nach Angioplastie

 

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Zusammenfassung

Ziel: Für die endovaskuläre Brachytherapie stehen unterschiedliche Radionuklide zur Verfügung. Ein interessantes Konzept ist die Nutzung eines flüssigen Betastrahlers in einem Ballonkatheter. Re-188 kann aus einem Generatorsystem gewonnen werden und steht somit täglich zur Verfügung. Es sollten dosimetrische Daten erhoben werden. Methode: Es wurde die radiale Abnahme der Dosis von Re-188 bei einem typischen Dilatationskatheter (Durchmesser 3 mm, Länge 20 mm) berechnet und mit TLD-Messungen verglichen. Ergebnisse: Bei einer spezifischen Aktivität von 370 MBq/ml konnten 0,3 Gy pro 1 min in 0,5 mm Abstand von der Ballonwand gemessen werden. Doppelmessungen wiesen eine Abweichung von 3% auf. Ein schneller Dosisabfall von 50% innerhalb von 0,5 mm bzw. von 90% innerhalb von 2,5 mm wurde beobachtet. Meßwerte und Berechnungen stimmten gut überein. Die Daten von Re-188 und Y-90 entsprechen sich weitgehend. Schlußfolgerung: Berechnungen über die Dosisverteilung von Re-188 stimmen mit TLD-Messungen gut überein. Bei einer spezifischen Aktivität von 1,85 GBq/ml können in 2-3 Minuten 10-15 Gy an der Gefäßwand einer Koronararterie appliziert werden. Gegenüber radioaktiven Stents oder radioaktiven Drähten bietet sich hiermit eine einfache Alternative für die Prävention der Restenose an.

Summary

Aim: Various radionuclides can be used for endovascular brachytherapy. A new concept is to inflate the balloon of a dilitation catheter with a radioactive solution. Re-188 can be eluated from a generator system and is available daily. The aim of this study was to obtain dosimetric data for this radionuclide. Methods: The dose decrease of Re-188 was calculated and measured with a TLD-system radial to a balloon catheter typically used in cardiology (diameter: 3 mm, length: 20 mm). Results: Using a specific acitivity of 370 MBq/ml a dose of 0,3 Gy could be achieved within 1 min in a TLD in contact with the balloon. Paired TLDs differed about 3%. A fast dose reduction of 50% and 10% were stated within 0.5 mm and 2.5 mm, respectively. Calculated and measured values were in good agreement. The data are comparable to those known for Y-90. Conclusion: Calculations of dose distribution are consistent with TLD measurements of Re-188. Using a specific acitivity of 1.85 GBq/ml, a dose of 10-15 Gy at the coronary artery wall can be achieved within 2-3 min. Compared to radioactive stents or wires the use of this liquid beta-emitter is a simple alternative for prevention of the restenosis following the angioplasty.

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