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Arquivos Brasileiros de CardiologiaResumo das Próximas PublicaçõesAno 2001
Intracoronary Brachytherapy in the Treatment of In-stent Restenosis. Initial Experience in Brazil
Fábio Sândoli de Brito Jr, Rodrigo Hanriot, Breno Oliveira Almeida, Miguel Antonio Neves Rati, Nadia Sueli de Medeiros, Mônica Lagatta, José Carlos da Cruz, João Victor Salvajoli, Marco Antonio Perin
Intracoronary brachytherapy using beta or gamma radiation is currently the most efficient type of therapy for preventing the recurrence of coronary in-stent restenosis. Its implementation depends on the interaction among interventionists, radiotherapists, and physicists to assure the safety and quality of the method. The authors report the pioneering experience in Brazil of the treatment of 2 patients with coronary in-stent restenosis, in whom beta radiation was used as part of the international multicenter randomized PREVENT study (Proliferation REduction with Vascular ENergy Trial). The procedures were performed rapidly and did not require significant modifications in the traditional techniques used for conventional angioplasty. Alteration in the radiological protection devices of the hemodynamic laboratory were also not required, showing that intracoronary brachytherapy using beta radiation can be incorporated into the interventional tools of cardiology in our environment.
As a direct consequence of the dizzying growth of the number of stents implanted, problems related to restenosis of these metallic endoprostheses have arisen. The incidence of restenosis ranges from 10% to 35% 1, depending on the population studied, resulting fundamentally from exacerbation of neointimal hyperplasia2. Independent of the device used, the treatment of coronary in-stent restenosis is associated with high rates of recurrence (>30%), which may even exceed 50% when the restenosis is long and diffuse 1-3. More recently, encouraging results from clinical studies using coronary radiotherapy (beta or gamma rays) 4-7 have introduced new perspectives for the treatment of this problem. The authors report the 2 pioneering cases that introduced this new type of therapy into Brazil.
Hospital Israelita Albert Einstein
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