Brachytherapy with iridium-192 HDR to prevent from restenosis in peripheral arteries

Abstract

The use of stents does not appreciably improve restenosis (usually resulting from intimal hyperplasia) as compared to percutaneous transluminal angioplasty (PTA) alone. The development of small-caliber probes for afterloading therapy in the biliary tract allowed us to use these for therapy in the vascular system. Using a special 9 F catheter, exact measurement of the length of the stented vascular segment and of the insertion length of the afterloading probe could be reproducibly performed. We used a Nucletron (Micro) Selectron HDR planning system version 10.10 for exact calculation, monitoring, and control of the afterloading procedure. Our source was iridium 192 (10 Ci) with a diameter of 1.1 mm. The program controls and monitors the insertion and removal of the iridium probe from the source into the special catheter through to the tip, and monitors the irradiation duration. The exposure time was around 200 seconds for a surface dose of 12 Gy. To date, a total of 40 patients have been treated with endovascular afterloading. All patients suffered from clinically relevant reocclusions or restenoses in stented vascular segments of the superficial femoral artery following successful PTA or laser treatment, within 6 to 8 months after the last therapy. In all patients it was possible to perform re-PTA treatment without remaining residual stenoses in the stented region. The additional time required as compared to PTA alone was approximately 45 minutes with most of this time spending for transportation between the cath lab and afterloading room. The follow-up period of the 40 patients ranged from 4 months to 71/2 years. In 33 patients, there was no deterioration of the clinical stage and no restenosis. One patient suffered from an acute thrombosis approximately 3 months after stent implantation, another patient had a stenosis 3 cm above the stented vascular segment 12 months after irradiation treatment. Follow-up examinations have revealed no evidence of nerve lesions following irradiation therapy. The tissue surrounding the artery showed no change following irradiation therapy, either in the CT, color-coded Doppler, endovascular ultrasonic scan or MRI. No complaints of discomfort were reported during or after irradiation. With the exceptions mentioned above, there was no evidence of any complications.

Endovascular brachytherapy in peripheral arteries: Solution for restenosis or false hope?

“…Excellent results from a clinical phase I/II trial were reported in a limited number of patients (n = 28), even after a long follow-up period (6 years), with a binary restenosis rate of 23% (Tables 1 and 2) [9].…”

Endovaskuläre Brachytherapie als neue Therapieoption zur Prophylaxe der Rezidivstenose nach peripherer Katheterintervention

“…Eine Dosis von 12 Gy in 3 mm Abstand von der Quellenachse wurde mit einem 192-Iridium-HDR-Afterloading-Gerät verabreicht.Die 5-Jahres-Offenheitsrate (klinisch und dopplersonographisch) betrug 82%. Strahleninduzierte Spätschä-den wurden nicht beobachtet [10].…”

Present Status of Endovascular Brachytherapy in Peripheral Arteries

“…Excellent results from a clinical phase I/II trial in a limited number of patients (n = 28) were reported, even after a long follow-up period (6 years), with a clinical restenosis rate of 13%. The dose was prescribed and reported at 3 mm from the source axis using the iridium-192 high-dose rate brachytherapy [1,3,9].…”