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Irradiation for stent stenosis

Intracoronary irradiation with iridium-192 reduces the rates of stent restenosis but is associated with a higher rate of late thrombosis and risk of myocardial infarction.

By | February 1, 2001

Intracoronary irradiation with iridium-192 reduces the rates of stent restenosis but is associated with a higher rate of late thrombosis and risk of myocardial infarction.

After coronary stenting, patients with angina have a high risk of in-stent restenosis. The treatment options for restenosis are limited but low-dose internal radiotherapy has recently emerged as a new way to prevent this complication.

A US, double-blind, randomised trial, published in the 25 January issue of New England Journal of Medicine investigated the role of radiation therapy in the treatment of in-stent restenosis (N Engl J Med 2001, 344:250-256).

Martin B. Leon from the Cardiovascular Research Foundation, Lenox Hill Hospital, New York and colleagues from seven other US cardiology centres studied 252 patients in whom in-stent restenosis had developed. They found that intracoronary irradiation with iridium-192 resulted in lower rates of clinical and angiographic restenosis (28.2%), when compared to a placebo (43.8%, p=0.02). But the technique was associated with a higher rate of late thrombosis, resulting in an increased risk of myocardial infarction.

If the problem of late thrombosis within the irradiation can be overcome with medication, intracoronary irradiation may become a useful approach to the treatment of patients with in-stent stenosis.

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