FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 346:1194-1199 April 18, 2002 Number 16 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Perspective by Cannon, R. O. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article PubMed Citation

ABSTRACT

Background Intracoronary radiation therapy is effective in reducing the recurrence of in-stent stenosis in native coronary arteries. We examined the effects of intravascular gamma radiation in patients with in-stent restenosis of saphenous-vein bypass grafts.

Methods A total of 120 patients with in-stent restenosis in saphenous-vein grafts, the majority of whom had diffuse lesions, underwent balloon angioplasty, atherectomy, additional stenting, or a combination of these procedures. If the intervention was successful, the patients were randomly assigned in a double-blind fashion to intravascular treatment with a ribbon containing either iridium-192 or nonradioactive seeds. The prescribed dose, delivered at a distance of 2 mm from the source, was 14 to 15 Gy in vessels that were 2.5 to 4.0 mm in diameter and 18 Gy in vessels with a diameter that exceeded 4.0 mm. The primary end points were death from cardiac causes, Q-wave myocardial infarction, revascularization of the target vessel, and a composite of these events at 12 months.

Results Revascularization and radiation therapy were successfully accomplished in all patients. At six months, the restenosis rate was lower in the 60 patients assigned to the iridium-192 group than in the 60 assigned to the placebo group (21 percent vs. 44 percent, P=0.005). At 12 months, the rate of revascularization of the target lesion was 70 percent lower in the iridium-192 group than in the placebo group (17 percent vs. 57 percent, P<0.001), and the rate of major cardiac events was 49 percent lower (32 percent vs. 63 percent, P<0.001).

Conclusions The results of our study support the use of gamma-radiation therapy for the treatment of in-stent restenosis in patients with bypass grafts.

Source Information

From Washington Hospital Center and the Washington Cancer Institute at Washington Hospital Center, Washington, D.C. (R.W., A.E.A., R.L.W., R.C.C., L.F.S., K.M.K., A.D.P., E.E.P., A.B.B., J.L.); the Oschner Clinic, New Orleans (S.R.); and the Scripps Clinic, San Diego, Calif. (P.T.).

Address reprint requests to Dr. Waksman at the Division of Cardiology, Washington Hospital Center, 110 Irving St., NW, Suite 4B-1, Washington, DC 20010, or at ron.waksman{at}medstar.net.

Full Text of this Article

Related Letters:

Brachytherapy and Saphenous-Vein Grafts
Sharma S., Nyitray W., Bhambi B., Waksman R., Ajani A. E.
Extract | Full Text | PDF  
N Engl J Med 2002; 347:692-693, Aug 29, 2002. Correspondence

This article has been cited by other articles:

• Holmes, D. R. Jr, Teirstein, P. S., Satler, L., Sketch, M. H. Jr, Popma, J. J., Mauri, L., Wang, H., Schleckser, P. A., Cohen, S. A., SISR Investigators, (2008). 3-Year Follow-Up of the SISR (Sirolimus-Eluting Stents Versus Vascular Brachytherapy for In-Stent Restenosis) Trial. J Am Coll Cardiol Intv 1: 439-448 [Abstract] [Full Text]  
• Wilson, J. M., Willerson, J. T. (2008). Myocardial Revascularization with Percutaneous Devices. Card Surg Adult 3: 573-598 [Full Text]  
• Ferreira-Gonzalez, I., Permanyer-Miralda, G., Domingo-Salvany, A., Busse, J. W, Heels-Ansdell, D., Montori, V. M, Akl, E. A, Bryant, D. M, Alonso-Coello, P., Alonso, J., Worster, A., Upadhye, S., Jaeschke, R., Schunemann, H. J, Pacheco-Huergo, V., Wu, P., Mills, E. J, Guyatt, G. H (2007). Problems with use of composite end points in cardiovascular trials: systematic review of randomised controlled trials. BMJ 334: 786-786 [Abstract] [Full Text]  
• Hoffmann, R., Pohl, T., Koster, R., Blindt, R., Boeckstegers, P., Heitzer, T. (2007). Implantation of paclitaxel-eluting stents in saphenous vein grafts: clinical and angiographic follow-up results from a multicentre study. Heart 93: 331-334 [Abstract] [Full Text]  
• Vermeersch, P., Agostoni, P., Verheye, S., Van den Heuvel, P., Convens, C., Bruining, N., Van den Branden, F., Van Langenhove, G. (2006). Randomized Double-Blind Comparison of Sirolimus-Eluting Stent Versus Bare-Metal Stent Implantation in Diseased Saphenous Vein Grafts: Six-Month Angiographic, Intravascular Ultrasound, and Clinical Follow-Up of the RRISC Trial. J Am Coll Cardiol 48: 2423-2431 [Abstract] [Full Text]  
• Scheller, B., Hehrlein, C., Bocksch, W., Rutsch, W., Haghi, D., Dietz, U., Bohm, M., Speck, U. (2006). Treatment of Coronary In-Stent Restenosis with a Paclitaxel-Coated Balloon Catheter. NEJM 355: 2113-2124 [Abstract] [Full Text]  
• (2006). Additional Information. JAMA 295: E1-E6 [Full Text]  
• Holmes, D. R. Jr, Teirstein, P., Satler, L., Sketch, M., O'Malley, J., Popma, J. J., Kuntz, R. E., Fitzgerald, P. J., Wang, H., Caramanica, E., Cohen, S. A., for the SISR Investigators, (2006). Sirolimus-Eluting Stents vs Vascular Brachytherapy for In-Stent Restenosis Within Bare-Metal Stents: The SISR Randomized Trial. JAMA 295: 1264-1273 [Abstract] [Full Text]  
• Smith, S. C. Jr, Feldman, T. E., Hirshfeld, J. W. Jr, Jacobs, A. K., Kern, M. J., King, S. B. III, Morrison, D. A., O'Neill, W. W., Schaff, H. V., Whitlow, P. L., Williams, D. O., Antman, E. M., Smith, S. C. Jr, Adams, C. D., Anderson, J. L., Faxon, D. P., Fuster, V., Halperin, J. L., Hiratzka, L. F., Hunt, S. A., Jacobs, A. K., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B. (2006). ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). J Am Coll Cardiol 47: 216-235 [Full Text]  
• Smith, S. C. Jr, Feldman, T. E., Hirshfeld, J. W. Jr, Jacobs, A. K., Kern, M. J., King, S. B. III, Morrison, D. A., O'Neill, W. W., Schaff, H. V., Whitlow, P. L., Williams, D. O., Antman, E. M., Smith, S. C. Jr, Adams, C. D., Anderson, J. L., Faxon, D. P., Fuster, V., Halperin, J. L., Hiratzka, L. F., Hunt, S. A., Jacobs, A. K., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B. (2006). ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). Circulation 113: 156-175 [Full Text]  
• Authors/Task Force Members, , Silber, S., Albertsson, P., Aviles, F. F., Camici, P. G., Colombo, A., Hamm, C., Jorgensen, E., Marco, J., Nordrehaug, J.-E., Ruzyllo, W., Urban, P., Stone, G. W., Wijns, W. (2005). Guidelines for Percutaneous Coronary Interventions: The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J 26: 804-847 [Full Text]  
• Montori, V. M, Jaeschke, R., Schunemann, H. J, Bhandari, M., Brozek, J. L, Devereaux, P J, Guyatt, G. H (2004). Users' guide to detecting misleading claims in clinical research reports. BMJ 329: 1093-1096 [Full Text]  
• Waksman, R. (2004). Vascular brachytherapy and coronary stenting for de novo lesions: Love on the rocks. J Am Coll Cardiol 44: 538-540 [Full Text]  
• Walter, D. H., Cejna, M., Diaz-Sandoval, L., Willis, S., Kirkwood, L., Stratford, P. W., Tietz, A. B., Kirchmair, R., Silver, M., Curry, C., Wecker, A., Yoon, Y.-S., Heidenreich, R., Hanley, A., Kearney, M., Tio, F. O., Kuenzler, P., Isner, J. M., Losordo, D. W. (2004). Local Gene Transfer of phVEGF-2 Plasmid by Gene-Eluting Stents: An Alternative Strategy for Inhibition of Restenosis. Circulation 110: 36-45 [Abstract] [Full Text]  
• Krueger, K., Zaehringer, M., Bendel, M., Stuetzer, H., Strohe, D., Nolte, M., Wittig, D., Mueller, R.-P., 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 [Abstract] [Full Text]  
• Bruno, S., Remuzzi, G., Ruggenenti, P. (2004). Transplant Renal Artery Stenosis. J. Am. Soc. Nephrol. 15: 134-141 [Abstract] [Full Text]  
• Schachinger, V., Hamm, C. W., Munzel, T., Haude, M., Baldus, S., Grube, E., Bonzel, T., Konorza, T., Koster, R., Arnold, R., Haase, J., Probst, P., vom Dahl, J., Neumann, F.-J., Mudra, H., Hennen, B., Thiele, L., Zeiher, A. M., STING (STents IN Grafts) Investigators, (2003). A randomized trial of polytetrafluoroethylene-membrane-covered stents compared with conventional stents in aortocoronary saphenous vein grafts. J Am Coll Cardiol 42: 1360-1369 [Abstract] [Full Text]  
• Baim, D. S. (2003). Percutaneous treatment of saphenous vein graft disease: The ongoing challenge. J Am Coll Cardiol 42: 1370-1372 [Full Text]  
• Waksman, R., Lew, R., Ajani, A. E., Pichard, A. D., Satler, L. F., Kent, K. M., Chan, R., White, R. L., Suddath, W. O., Pinnow, E., Torguson, R., Dilcher, C., Wolfram, R., Lindsay, J. (2003). Repeat Intracoronary Radiation for Recurrent In-Stent Restenosis in Patients Who Failed Intracoronary Radiation. Circulation 108: 654-656 [Abstract] [Full Text]  
• Teirstein, P. S., King, S. (2003). Vascular Radiation in a Drug-Eluting Stent World: It's Not Over Till It's Over. Circulation 108: 384-385 [Full Text]  
• Waksman, R., Weinberger, J. (2003). Coronary Brachytherapy in the Drug-Eluting Stent Era: Don't Bury It Alive. Circulation 108: 386-388 [Full Text]  
• Traverse, J. H., Mooney, M. R., Pedersen, W. R., Madison, J. D., Flavin, T. F., Kshettry, V. R., Henry, T. D., Eales, F., Joyce, L. D., Emery, R. W. (2003). Clinical, Angiographic, and Interventional Follow-Up of Patients With Aortic-Saphenous Vein Graft Connectors. Circulation 108: 452-456 [Abstract] [Full Text]  
• Bartels, C., Erasmi, A., Sayk, F., Eggers, R., Dendorfer, A., Feyerabend, T., Eichler, W., Sievers, Hans.-H. (2003). Prophylactic gamma radiation of unaffected vein grafts failed to prevent vein graft disease in a chronic hypercholesterolemic porcine model. Eur. J. Cardiothorac. Surg. 24: 92-97 [Abstract] [Full Text]  
• Losordo, D. W., Isner, J. M., Diaz-Sandoval, L. J. (2003). Endothelial Recovery: The Next Target in Restenosis Prevention. Circulation 107: 2635-2637 [Full Text]  
• Schiele, T M, Regar, E, Silber, S, Eeckhout, E, Baumgart, D, Wijns, W, Colombo, A, Rutsch, W, Meerkin, D, Gershlick, A, Bonan, R, Urban, P (2003). Clinical and angiographic acute and follow up results of intracoronary {beta} brachytherapy in saphenous vein bypass grafts: a subgroup analysis of the multicentre European registry of intraluminal coronary {beta} brachytherapy (RENO). Heart 89: 640-644 [Abstract] [Full Text]  
• Waksman, R., Cheneau, E., Ajani, A. E., White, R. L., Pinnow, E., Torguson, R., Deible, R., Satler, L. F., Pichard, A. D., Kent, K. M., Teirstein, P. S., Lindsay, J. (2003). Intracoronary Radiation Therapy Improves the Clinical and Angiographic Outcomes of Diffuse In-Stent Restenotic Lesions: Results of the Washington Radiation for In-Stent Restenosis Trial for Long Lesions (Long WRIST) Studies. Circulation 107: 1744-1749 [Abstract] [Full Text]  
• Seabra-Gomes, R (2003). In-stent restenosis: intracoronary {beta}-radiation at the crossroads. Eur Heart J 24: 583-585 [Full Text]  
• Ajani, A. E., Waksman, R., Cheneau, E., Cha, D.-H., McGlynn, S., Castagna, M., Chan, R. C., Satler, L. F., Kent, K. M., Pichard, A. D., Pinnow, E., Lindsay, J. (2003). The outcome of percutaneous coronary intervention in patients with In-Stentrestenosis who failed intracoronary radiation therapy. J Am Coll Cardiol 41: 551-556 [Abstract] [Full Text]  
• Faxon, D. (2002). Restenosis: do we need to understand it to treat it?. J Am Coll Cardiol 40: 2090-2091 [Full Text]  
• Prpic, R., Teirstein, P. S., Reilly, J. P., Moses, J. W., Tripuraneni, P., Lansky, A. J., Giorgianni, J.-A., Jani, S., Wong, S. C., Fish, R. D., Ellis, S., Holmes, D. R., Kereiakas, D., Kuntz, R. E., Leon, M. B. (2002). Long-Term Outcome of Patients Treated With Repeat Percutaneous Coronary Intervention After Failure of {gamma}-Brachytherapy for the Treatment of In-Stent Restenosis. Circulation 106: 2340-2345 [Abstract] [Full Text]  
• Sharma, S., Nyitray, W., Bhambi, B., Waksman, R., Ajani, A. E. (2002). Brachytherapy and Saphenous-Vein Grafts. NEJM 347: 692-693 [Full Text]  
• Kandzari, D. E., Mark, D. B. (2002). Intracoronary Brachytherapy: Time to Sell Short?. Circulation 106: 646-648 [Full Text]  
• (2002). Brachytherapy for SVG In-Stent Restenosis. Journal Watch Cardiology 2002: 1-1 [Full Text]  
• Wang, X., Paigen, B. (2002). Comparative Genetics of Atherosclerosis and Restenosis: Exploration With Mouse Models. Arterioscler. Thromb. Vasc. Bio. 22: 884-886 [Full Text]  
• Hambleton, J., Leung, L. L., Levi, M. (2002). Coagulation: Consultative Hemostasis. ASH Education Book 2002: 335-352 [Abstract] [Full Text]