Initial benefit of intracoronary radiation with stenting not sustained
Monday, 29 November 1999 19:00 | 
| Medicexchange News - Medicexchange News |
Five-year follow up data of a clinical trial confirm that beta-irradiation at the time of bare metal stent placement in de novo coronary stenoses only transiently prevents neointimal proliferation leading to restenosis.
Five-year follow up data of a clinical trial confirm that beta-irradiation at the time of bare metal stent placement in de novo coronary stenoses only transiently prevents neointimal proliferation that often leads to restenosis.
Vascular brachytherapy significantly reduced in-stent recurrences at six months compared with bare metal stents only, but this initial benefit was not sustained in the long term, Dr. Valeria Ferrero of University of Verona, Italy and colleagues in a report in the American Heart Journal for March.
"The results of this randomized study confirm the delayed and progressive restenotic process after beta-irradiation and stent implantation in de novo lesions," they write.
The study involved 61 patients (64 de novo coronary lesions) treated with bare metal stent implantation, 30 of whom (31 stenoses) also received intracoronary beta-irradiation at the time of angioplasty and stent placement.
At 6 months, radiation plus stenting, compared to stenting alone, reduced the need for revascularization of the target vessel (13 vs 35.5 per cent, p = 0.04), although clinical event rates and event-free survival at 6- and 12-months were similar in the two groups.
"Between one and five years, an increasing number of target vessel failures was observed in both groups, leading to a similar long-term clinical outcome at five years," the authors report. The five-year event-free survival was 43 per cent with radiation plus stenting and 45 per cent with stenting only.
"This late catch-up phenomenon, together with natural progression of atherosclerotic disease in other segments, is responsible for the loss of the clinical benefit of vascular brachytherapy in the long term," Dr. Ferrero's team notes.
"Our results underline the need for very long-term follow-up when evaluating the efficacy of new potent antiproliferative strategies," they conclude.
Vascular brachytherapy significantly reduced in-stent recurrences at six months compared with bare metal stents only, but this initial benefit was not sustained in the long term, Dr. Valeria Ferrero of University of Verona, Italy and colleagues in a report in the American Heart Journal for March.
"The results of this randomized study confirm the delayed and progressive restenotic process after beta-irradiation and stent implantation in de novo lesions," they write.
The study involved 61 patients (64 de novo coronary lesions) treated with bare metal stent implantation, 30 of whom (31 stenoses) also received intracoronary beta-irradiation at the time of angioplasty and stent placement.
At 6 months, radiation plus stenting, compared to stenting alone, reduced the need for revascularization of the target vessel (13 vs 35.5 per cent, p = 0.04), although clinical event rates and event-free survival at 6- and 12-months were similar in the two groups.
"Between one and five years, an increasing number of target vessel failures was observed in both groups, leading to a similar long-term clinical outcome at five years," the authors report. The five-year event-free survival was 43 per cent with radiation plus stenting and 45 per cent with stenting only.
"This late catch-up phenomenon, together with natural progression of atherosclerotic disease in other segments, is responsible for the loss of the clinical benefit of vascular brachytherapy in the long term," Dr. Ferrero's team notes.
"Our results underline the need for very long-term follow-up when evaluating the efficacy of new potent antiproliferative strategies," they conclude.
