PubMed · 10973370
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R Bonan. 2000. Short, small and single!. https://pubmed.ncbi.nlm.nih.gov/10973370/
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Rhenium-188 is reported to be one of the best radionuclides for intracoronary balloon brachytherapy. Among several preparations of (188)Re available for brachytherapy, (188)Re-diethylene triamine penta-acetic acid (DTPA) and (188)Re-mercaptoacetyltriglycine (MAG3) are recommended owing to their rapid excretion via the renal system and the absence of accumulation in the thyroid. The aim of this study was to calculate the dose of radiation exposure in a real human accident. During a 4-year clinical trial of (188)Re-DTPA balloon brachytherapy in 242 patients, there was one accident involving balloon leakage. Dosimetry was performed by both image-based and biological analysis. The radiation exposure to the whole body was calculated as 113 mGy by image-based analysis and 83 or 88 mGy by biological analysis, which was approximately half the reported dose in the case of (188)Re-perrhenate. The radiation exposures to other vital organs were also within the tolerated ranges. We conclude that (188)Re-DTPA has better clinical feasibility and safety for intracoronary balloon brachytherapy than (188)Re-perrhenate.
BACKGROUND: Restenosis requiring reintervention is the main limitation of coronary angioplasty. Intracoronary irradiation reduces neointimal proliferation. We studied the efficacy of a self-centering liquid rhenium-188-filled balloon catheter for coronary beta-brachytherapy. METHODS AND RESULTS: After successful coronary angioplasty with or without stenting, 225 patients (71% de novo lesions) were randomly assigned to receive 22.5 Gy intravascular beta-irradiation in 0.5-mm tissue depth (n=113) or to receive no additional intervention (n=112). Clinical and procedural data did not differ between the groups except a higher rate of stenting in the control group (63%) compared with the rhenium-188 group (45%, P<0.02). After 6 months of follow-up, late loss was significantly lower in the irradiated group compared with the control group, both of the target lesion (0.11+/-0.54 versus 0.69+/-0.81 mm, P<0.0001) and of the total segment (0.22+/-0.67 versus 0.70+/-0.82 mm, P<0.0001). This was also evident in the subgroup of patients with de novo lesions and independent from stenting. Binary restenosis rates were significantly lower at the target lesion (6.3% versus 27.5%, P<0.0001) and of the total segment (12.6% versus 28.6%, P<0.007) after rhenium-188 brachytherapy compared with the control group. Target vessel revascularization rate was significantly lower in the rhenium-188 (6.3%) compared with the control group (19.8%, P=0.006). CONCLUSIONS: Intracoronary beta-brachytherapy with a rhenium-188 liquid-filled balloon is safe and efficiently reduces restenosis and revascularization rates after coronary angioplasty.