Brachytherapy for prophylaxis of restenosis after long-segment femoropopliteal angioplasty:: Pilot study

PURPOSE: To evaluate ina pilot study the feasibility and: efficacy of endovascular brachytherapy for prophylaxis of restenosis after femoropopliteal percutaneous transluminal angioplasty (PTA) without stent implantation in:a group of:patients:with a high risk of restenosis. MATERIALS AND METHODS: Ten patients (six women four men; mean age, 68 years) with long-segment (mean length, 16 cm; range, 9-22 cm) restenosis underwent PTA followed by endovascular irradiation with high-dose-rate afterloading of an iridium- 192 rod. A dose of 12 Cy,was targeted to the inner intimal layer of the vessel. Follow-up examinations until l:months after PTA included measurement of the ankle-brachial index, color duplex ultrasonography (US) with calculation of the peak velocity ratio, and intraarterial angiography when recurrence was suspected. RESULTS: Irradiation was technically feasible in all patients without complications. In six patients, the dilated and irradiated segment remained widely patent at color US, with corresponding excellent hemodynamic and clinical: results after 12 months. In four patients, clinical and laboratory findings indicated recurrence and arteriography demonstrated restenosis with: a diameter reduction of 60%, 70%, 80%, or 90%. CONCLUSION: Considering the negative selection of patients with a high risk of restenosis, the results of our pilot study are promising:concerning the possibility of reduction of restenosis by means of endovascular brachytherapy after long-segment: femoropopliteal PTA without stent implantation. The value of this approach should now be determined definitively in randomized trials.