• Catheter-based systems
• Radioactive stents

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Vascular Radiotherapy Monitor - Remedica 
http://www.vrm.remedica.com
This web site (and its accompanying journal) has been developed to provide a guide to developments in the rapidly expanding field of vascular radiotherapy. Contents: reviews on world scientific literature for significant and important articles on vascular radiotherapy. 
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Website
Radiation Online
http://www.radiationonline.com/  
Radiation Online is a website developed by the Cardiovascular Brachytherapy Institute at the Washington Hospital Center to provide viewers with an educational perspective on the progress of vascular brachytherapy.  

Catheter-based systems  Archive 1992-2001

AHA 2002 Presentation

• Correlates of Radiation Failure for ISR, by Dr. Andrew E. Ajani
• Additional Stenting & IRT, by Dr. Edouard Cheneau

TCT 2002 Abstracts

• Vascular Brachytherapy

TCT 2002 Expert Presentations

ACC 2002 Meeting Coverage

Summaries of important articles from major peer-reviewed journals

Comparison of intracoronary gamma radiation for in-stent restenosis in saphenous vein grafts versus native coronary arteries
Ajani AE, et al.
Am J Cardiol 2003;91:22-6
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12505566
Treatment of ISR with gamma radiation in SVGs had similar outcome to native coronary arteries. The use of gamma radiation for the treatment of ISR should expand to SVGs.

Carotid brachytherapy for in-stent restenosis
Chan AW, et al.
Catheter Cardiovasc Interv 2003;58:86-92
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12508205 
Carotid stenting has emerged as an alternative revascularization modality to endarterectomy for the treatment of carotid artery disease. Restenosis of a carotid stent may be occasionally seen. This study reports the initial experience with brachytherapy for the treatment of restenosis after carotid stenting.

Costing out brachytherapy in the dawning era of drug-eluting stents
Cohen DJ et al; Kandzari DE & Mark DB. 
Circulation 2002;106:691-697; 646-648. [ Aug 08, 2002 ]
A new study shows that with certain improvements to techniques, brachytherapy is likely cost effective in certain patients. The big question is, should hospitals invest in brachytherapy when drug-eluting stents are poised to hit the market?

Brachytherapy benefits persist at 5 years, but face eclipse in the shadow of drug-eluting stents
Grise et al. 
Circulation 2002; 105: published online before print May 13, 2002. 
with slide / New data show intracoronary radiation using iridium-192 can significantly reduce target lesion revascularization over 5 years, although the effect appears to lessen with time. Despite the promising results, the technology may be pushed aside by drug-eluting stents. 

Histopathology of coronary in-stent restenosis following gamma brachytherapy
Lowe HC, et al.
Heart 2003;89:11-3
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12482781 
The recurrent ISR was treated with directional coronary atherectomy; the histopathology of this directional coronary atherectomy specimen is discussed. These histopathological examinations showed abundant extracellular matrix material. Surprisingly, there was a relatively small cellular (myofibroblastic) component, with an absence of endothelial cells and little evidence of active proliferation. ISR after gamma brachytherapy may be a pathologically distinct entity.

Full text journal article March 2002
Combination Antiplatelet Therapy Following Brachytherapy with Restenting: "It Ain´t Over ´til the Fat Lady Sings"
This case-based experience explores optimal duration of antiplatelet therapy following brachytherapy with restenting.

Full text journal article March 2002
Late Stent Thrombosis in Brachytherapy: The Role of Long-term Antiplatelet Therapy
Determining duration of antiplatelet therapy after brachytherapy is pivotal to reduce risk of late stent thrombosis.

Full text journal article Jul 2002
Clinical Trials of Intracoronary Gamma Radiation Therapy for In-Stent Restenosis
Brachytherapy is effective in reducing restenosis and trials indicate the therapy is beneficial for in-stent restenosis.

The impact of lesion length and reference vessel diameter on angiographic restenosis and target vessel revascularization in treating in-stent restenosis with radiation 
Ajani AE, et al. 
J Am Coll Cardiol 2002;39:1290-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11955846
Intracoronary radiation therapy, compared to placebo, results in a significant reduction of angiographic restenosis across all vessel sizes, with a trend toward reduction of angiographic restenosis across all lesion lengths; this effect is seen predominantly in small vessels and diffuse lesions.

Device selection in the treatment of in-stent restenosis with and without radiation (from the Gamma Radiation Trials)
Ajani AE, et al. 
Am J Cardiol 2002;89:137-44.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11792331
The overall recurrence rate of ISR was lower in patients treated with gamma radiation using iridium-192 compared with placebo. Device selection did not influence late clinical outcomes in irradiated and nonirradiated groups.

Repeated intracoronary beta radiation for recurrent in-stent restenosis 
De Benedetti E, et al. 
Catheter Cardiovasc Interv 2002;55:233-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11835654
A case report of recurrent in-stent restenosis after vascular brachytherapy that was successfully treated by a second beta radiation treatment.

Restenosis: Intracoronary Brachytherapy 
Drachman DE, et al. 
2002;4:109-118
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11858773
The benefits of intracoronary brachytherapy may be particularly pronounced in certain patient subgroups (eg, those with diabetes, long lesions, or lesions in saphenous vein bypass grafts), but comes at the cost of an increased rate of late stent thrombosis and the need for extended antiplatelet therapy. The role of brachytherapy in the arsenal of the interventional cardiologist will continue to evolve, particularly in light of the unprecedented recent advances with the use of drug-eluting stents for restenosis prevention

Intracoronary radiation: are the frequent flyers still around? 
Hehrlein C. 
Catheter Cardiovasc Interv 2002;55:237-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11835655

Quantitative angiographic methods for appropriate end-point analysis, edge-effect evaluation, and prediction of recurrent restenosis after coronary brachytherapy with gamma irradiation 
Lansky AJ, et al. 
J Am Coll Cardiol 2002;39:274-80.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11788219
In WRIST, not only was (192)Ir therapy effective in reducing restenosis, but it also reduced the lesion length of treatment failures by 50%, and it was not associated with edge proliferation. The restenosis rate obtained from the vessel segment inclusive of the dose fall-off zones was the best correlate of TVR and should become a standard analysis site in all vascular brachytherapy trials.

High-dose intravascular beta-radiation after de novo stent implantation induces coronary artery spasm 
Scheinert D, et al. 
Circulation 2002;105:1420-3.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11914248
http://www.circulationaha.org/cgi/content/full/105/12/1420
http://www.circulationaha.org/cgi/content/abstract/105/12/1420
Vasoconstriction is a frequent reaction of coronary arteries after high-dose intracoronary beta- radiation, necessitating repetitive administration of vasodilators.

Intravascular gamma radiation for in-stent restenosis in saphenous-vein bypass grafts 
Waksman R, et al. 
N Engl J Med 2002;346:1194-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11961147
http://content.nejm.org/cgi/content/full/346/16/1194
http://content.nejm.org/cgi/content/abstract/346/16/1194
The results of our study support the use of gamma-radiation therapy for the treatment of in-stent restenosis in patients with bypass grafts.
Gamma-radiation reduces in-stent restenosis in saphenous-vein bypass grafts: SVG WRIST published
with slide / Results of the SVG WRIST trial, which support the use of intracoronary gamma radiation to prevent in-stent restenosis in patients with saphenous vein bypass grafts, have been published. Vascular brachytherapy should be expanded for use in these patients, say the authors. 

Use of localised intracoronary beta radiation in treatment of in-stent restenosis: the INHIBIT randomised controlled trial
Waksman R, et al. 
Lancet 2002;359:551-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11867107
Vascular brachytherapy using pure beta-emitter 32P delivered into a centreing catheter via an automatic afterloader can be used to reduce overall revascularisation in patients undergoing treatment for diffuse in-stent restenosis.
INHIBIT brachytherapy results published in the Lancet Nine-month results from the INHIBIT trial, showing a reduction in MACE and binary restenosis, but a slight increase in late thrombosis, MI, and deaths with brachytherapy over placebo, have now been published. Initial enthusiam for the method has been eclipsed somewhat by the excitement over drug-coated stents.

Angiographical follow-up after radioactive "Cold Ends" stent implantation: a multicenter trial
Wardeh AJ, et al.
Circulation 2002;105:550-3.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11827917
http://www.circulationaha.org/cgi/content/full/105/5/550
http://www.circulationaha.org/cgi/content/abstract/105/5/550
Cold Ends stents did not resolve edge restenosis.