Treatment of Diffuse In-Stent Restenosis Combined with Cutting Balloon Angioplasty and Intracoronary Holmium Brachytherapy

BACKGROUND AND OBJECTIVES: A cutting balloon angioplasty for the treatment of diffuse in-stent restenosis has been reported to be superior to conventional percutaneous transluminal coronary angioplasty. Intracoronary radiation therapy is also a novel technique for preventing a recurrence of in-stent restenosis following percutaneous coronary intervention. Holmium (166Ho) is a high-energy beta-emitter, which is available in liquid form. We performed a cutting balloon angioplasty, with subsequent intracoronary 166Ho brachytherapy, for the treatment of in-stent restenosis. SUBJECTS AND METHODS: Fifty two patients, with in-stent restenosis, were treated with cutting balloon angioplasy and intracoronary 166Ho brachytherapy. For the irradiation, a balloon approximately 10 mm longer than the stent was used. Radiation doses of 18 Gy at a depth of 1 mm from balloon-artery interface were used. A quantitative coronary angiography was performed during the procedure and at the 6-month follow-up. The patients were followed clinically for an average of 16.8+/-9.8 months. RESULTS: The procedures were successful in all patients. The minimal luminal diameter of in-stent restenosis lesions, initially and after treatment, and the lesion length were 0.58+/-0.30 and 2.55+/-0.29 mm, and 20.7+/-7.1 mm, respectively. Thirty four (65.4%) patients completed the angiographic follow-up at 6 months. The minimal luminal diameter of lesion and late loss were 2.03+/-0.83 and 0.57+/-0.79 mm, respectively. The target lesion restenosis rate was 14.7%. No patients presented with MACE, such as MI, death or stent thrombosis. CONCLUSION: The combination of cutting balloon angioplasty and intracoronary 166Ho brachytherapy was feasible, safe and effective for the treatment of diffuse in-stent restenosis.

The change and clinical significance of serum tumor necrosis factor-?、interleukin-6 and interleukin-8 after cutting balloon angioplasty and stent implantation / 中国介入心脏病学杂志

Objective To evaluate the effect of cutting balloon angioplasty and stent implantation on serum TNF ?, IL 6 and IL 8, and investigate the relationship between the concentrations of serum TNF ?, IL 6 and IL 8 after operation and the incidences of late cardiac events after intervention Methods Eighty patients underwent PTCA with normal balloon or cutting balloon Values of serum TNF ?, IL 6 and IL 8 before and after intervention were measured using enzyme linked immuno sorbent assay Results The concentrations of serum TNF ?, IL 6 and IL 8 were increased significantly in the restenosis group, especially in the POBA group There was no obvious difference in no restenosis group Conclusion The lower restenosis rate in cutting balloon group was related to its lower injury and inflammation of blood vessels The concentrations of serum TNF ?, IL 6 and IL 8 6 hours after intervention may be the predictable sign of restenosis after intervention

Cutting balloon angioplasty for treatment of lesions in small coronary arteries / 介入放射学杂志

Objective To evaluate the clinical efficacy of cutting balloon angioplasty (CBA) for treating lesions in small coronary arteries. Methods The diameter for reference of coronary artery is less than 2.7mm which is considered as “small vessel”. CBA procedures were performed on 25 lesions in 22 patients. Results The procedure was successfully obtained in 21 lesions(84%). Seven severe stenotic lesions (diameter of stenosis≥90%) underwent dilatation with small conventional balloon(1.5 mm diameter). Bail out stenting was performed in 2 lesions because of severe dissections. Failure of cutting balloon to pass through the stenosis in one lesion. During follow up, 5 patients had recurrence of coronary angina and 3 of them underwent coronary angiography for check up, In stent restenosis (ISR) occurred in one patient, which was successfully redilated using CBA. One patient had total occlusion of the diagonal branch with ISR of LAD. One patient developed new lesion in other coronary artery.Conclusions CBA is safe and effective, and provides a new therapeutic strategy for lesions in the small coronary arteries.