Intracoronary beta-radiation therapy with 90-yttrium for in-stent restenosis resulted in a 6-month binary angiographic restenosis rate of 22%, significantly lower than historical placebo controls.
Cohort (n=50)
Does intracoronary beta-radiation therapy with 90-yttrium reduce angiographic and clinical restenosis in patients with in-stent restenosis?
Intracoronary beta-radiation with 90-yttrium as an adjunct therapy significantly reduces angiographic and clinical restenosis in patients with in-stent restenosis.
BACKGROUND: Intracoronary gamma-radiation therapy reduces recurrent in-stent restenosis (ISR). This study, BETA WRIST (Washington Radiation for In-Stent restenosis Trial) was designed to examine the efficacy and safety of the beta-emitter 90-yttrium for the prevention of recurrent ISR. METHODS AND RESULTS: A total of 50 consecutive patients with ISR in native coronaries underwent percutaneous transluminal coronary angioplasty, laser angioplasty, rotational atherectomy, and/or stent implantation. Afterward, a segmented balloon catheter was positioned and automatically loaded with a 90-yttrium, 0.014-inch source wire that was 29 mm in length to deliver a dose of 20.6 Gy at 1.0 mm from the balloon surface. In 17 patients, manual stepping of the radiation catheter was necessary for lesions >25 mm in length. The radiation was delivered successfully to all patients, with a mean dwell time of 3.0+/-0.4 minutes. Fractionation of the dose due to ischemia was required in 11 patients. At 6 months, the binary angiographic restenosis rate was 22%, the target lesion revascularization rate was 26%, and the target vessel revascularization rate was 34%; all rates were significantly lower than those of the placebo group of gamma-WRIST. CONCLUSIONS: beta-Radiation with a 90-yttrium source used as adjunct therapy for patients with ISR results in a lower-than-expected rate of angiographic and clinical restenosis.
Waksman et al. (2000) conducted a cohort in In-stent restenosis (n=50). Intracoronary beta-radiation therapy (90-yttrium) vs. Historical placebo group (gamma-WRIST) was evaluated on Binary angiographic restenosis rate. Intracoronary beta-radiation therapy with 90-yttrium for in-stent restenosis resulted in a 6-month binary angiographic restenosis rate of 22%, significantly lower than historical placebo controls.