Prevention of vascular restenosis with radiation.

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RESUMO

Recently, ionizing radiation has been shown to decrease the proliferative response to injury in animal models of restenosis. The Scripps Coronary Radiation to Inhibit Proliferation Post-Stenting (SCRIPPS) trial was a double-blind, placebo-controlled, randomized trial to test this new treatment modality in restenotic stented human coronary arteries. Patients with previous restenosis and stent implantation were randomized to receive catheter-based radiation with Iridium-192 or a placebo using a catheter-based delivery system. Fifty-five patients were enrolled; 26 were assigned to Iridium-192 and 29 to the placebo. Follow-up angiography was obtained in 96% of patients. Restenosis was observed in 53.6% of placebo patients compared with only 16.7% of treated patients (P = 0.025). Late luminal loss was also significantly lower in the Iridium-192 group (0.38 +/- 1.06 mm vs 1.03 +/- 0.97 mm, P = 0.009). Clinical outcome also revealed a significant reduction in the need for target lesion revascularization in the Iridium-192 group (44.8% vs 11.5%, P = 0.008). In this preliminary study, catheter-based intracoronary radiotherapy substantially reduced the rate of subsequent restenosis. Clinical trials using gamma emitters, beta emitters, and beta-emitting radioactive stents are ongoing.

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