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Clinical and angiographic acute and follow up results of intracoronary β brachytherapy in saphenous vein bypass grafts: a subgroup analysis of the multicentre European registry of intraluminal coronary β brachytherapy (RENO)
  1. T M Schiele1,
  2. E Regar2,
  3. S Silber3,
  4. E Eeckhout4,
  5. D Baumgart5,
  6. W Wijns6,
  7. A Colombo7,
  8. W Rutsch8,
  9. D Meerkin9,
  10. A Gershlick10,
  11. R Bonan11,
  12. P Urban12,
  13. for the RENO Investigators
  1. 1Medizinische Klinik—Innenstadt, University Hospital, Munich, Germany
  2. 2Thoraxcenter, Rotterdam, Netherlands
  3. 3Müller-Klinik, Munich, Germany
  4. 4CHUV, Lausanne, Switzerland
  5. 5Universitätsklinikum, Essen, Germany
  6. 6OLV, Aalst, Belgium
  7. 7EMO Columbus, Milan, Italy
  8. 8Charité, Berlin, Germany
  9. 9Shaare Zedek, Jerusalem, Israel
  10. 10General Hospital, Glenfield, UK
  11. 11Montreal Heart Institute, Montreal, Canada
  12. 12La Tour Hospital, Geneva, Switzerland
  1. Correspondence to:
    Dr T M Schiele, Cardiology Department, Medizinische Klinik – Innenstadt, University Hospital, Ziemssenstrasse 1, 80336 Munich, Germany;
    Thomas.Schiele{at}medinn.med.uni-muenchen.de

Abstract

Objective: To assess clinically and angiographically the feasibility, safety, and effectiveness of vascular brachytherapy (VBT) in saphenous vein bypass grafts (SVG).

Patients and methods: 67 of 1098 (6.1%) consecutive patients of the European registry of intraluminal coronary β brachytherapy underwent treatment for 68 SVG lesions by VBT using a Sr/Y90 source train (BetaCath). Clinical follow up data were obtained for all of them after a mean (SD) of 6.3 (2.4) months and angiographic follow up was performed in 61 patients (91.0%) after 6.9 (2.0) months.

Results: 58 (86.6%) patients were men, their mean (SD) age was 66 (10) years, 28 (41.8%) had unstable angina, and 21 (31.3%) had diabetes. Fifty three (77.9%) lesions were in-stent restenosis, 13 (19.1%) de novo lesions, and 2 (3.0%) non-stented restenotic lesions. Mean (SD) reference diameter before the intervention was 4.19 (0.52) mm, mean (SD) lesion length was 23.56 (20.38) mm, and mean (SD) minimum lumen diameter measured 0.73 (0.62) mm. Mean (SD) acute gain was 3.02 (0.88) mm. The prescribed radiation dose was 20.1 (3.2) Gy. Pullback manoeuvres were performed in 17 (25.0%) of cases. Most patients received combined aspirin and thienopyridin treatment for 6 or 12 months after the procedure. Technical success was obtained in 62 (91.2%) treated lesions and in-hospital major adverse cardiac events occurred in 4.5%. At follow up, mean (SD) reference diameter was 4.20 (0.53) mm, minimum lumen diameter 2.94 (1.50) mm, and late loss 0.86 (1.25) mm. The overall major adverse cardiac events rate was 26.7%.

Conclusion: VBT of SVG is feasible and safe. At follow up the reintervention rate and cardiac morbidity and mortality seem to be favourable, considering that interventions in SVG usually are associated with the highest risks.

  • saphenous vein bypass graft
  • vascular brachytherapy
  • restenosis
  • stent
  • CABG, coronary artery bypass grafting
  • γ-WRIST, Washington radiation for in-stent restenosis trial
  • MACE, major adverse cardiac event
  • RENO, European registry of intraluminal coronary β brachytherapy
  • SCRIPPS-I, Scripps coronary radiation to inhibit proliferation poststenting
  • SVG, saphenous vein bypass grafts
  • VBT, vascular brachytherapy

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    BMJ Publishing Group Ltd and British Cardiovascular Society