ABSTRACT
UNLABELLED: Clinical trials are increasingly investigating the effects of intracoronary radiation for the treatment of de-novo lesions, restenosis (without stents), and in-stent restenosis. As the first group in Germany, we had the opportunity to use the Novoste system within the international multicenter studies BETA-CATH, START and BRIE and report our preliminary experience regarding safety and feasibility of intracoronary brachytherapy with this afterloader. A total of 95 patients were enrolled. The Novoste system was used in 92 patients (104 lesions). Ischemic complications were not observed; therefore, radiation was performed as planned. The mean applied dose was 16 +/- 2 Gy (14-20 Gy, at 2 mm distance) and mean exposure time was 202 +/- 27 s (165-261 s). The addition of brachytherapy increased the total duration of the intervention for 17 +/- 8 min. At the body surface of the patients, the following dose rates were measured: left chest wall: 99 +/- 52 microSv/h; groin 3 +/- 3 microSv/h. All patients received ASS 300 mg/d o.d. Patients with stent implantation in the same session received 250 mg b.i.d. Ticlopidin or 75 mg Clopidogrel o.d. for at least three months. Total mortality and infarct rate was 0. There was no acute, subacute or late stent thrombosis. CONCLUSION: Our first experience with the Novoste Beta-Cath system showed that intracoronary brachytherapy can be safely and simply performed in the cath lab. There were no acute complications. To avoid the possible risk of late stent thrombosis, Ticlopidin or Clopidogrel must be administered for at least three months.
Subject(s)
Angioplasty, Balloon, Coronary/instrumentation , Brachytherapy/instrumentation , Coronary Disease/radiotherapy , Aged , Coronary Angiography , Dose-Response Relationship, Radiation , Equipment Design , Female , Follow-Up Studies , Germany , Humans , Male , Middle Aged , Multicenter Studies as Topic , Outcome and Process Assessment, Health Care , RecurrenceABSTRACT
Basing on the experiences collected with 127 patients, the pros and cons as well as the indications for intravenous angiography with conventional photographic subtraction technique (ISA) are discussed in comparison with rival procedures. ISA can be performed in every angiography unit without any additional investment, and its possibilities of use are identical with those of the DSA. As a matter of fact, it is a simple and safe method for visualising the renal arteries in the course of intravenous urography in the diagnostic evaluation of hypertension. For the first time, it has become possible to perform transvenous determination of the complete status of the arteries of the pelvis and legs, using a new technical system (simultaneous use of two film changers in the frontal plane--ISA aortoarteriography.
