Intracoronary brachytherapy: Initial Australasian experience with the Novoste Beta-Cath system

Background: Coronary artery stenting is now performed in the vast majority of percutaneous interventional procedures worldwide. In-stent restenosis remains the major limitation of this technology and responds poorly to conventional interventional therapies. The only available treatment shown to impact upon this unfavourable response is endovascular radiation. In this paper we describe the initial Australasian experience with the Novoste Beta-Cath device, designed specifically for the delivery of beta radiation to the coronary artery.

Methods: Patients were considered eligible for intracoronary brachytherapy if they had symptomatic diffuse in-stent restenosis, or restenosis within a vessel that was not suitable for stenting. Brachytherapy was provided as a clinical procedure following successful percutaneous transterminal coronary angioplasty (PTCA). Clinical and procedural details were collected at hospital admission, and patients were contacted a median of 9 months following the procedure. Information was collected on recurrent hospital presentations and details verified by retrieving patient records.

Results: From June 1999 to July 2000, intracoronary brachytherapy was performed in 17 vessels in 16 patients and was technically successful in all cases. A single late stent thrombosis occurred 80 days following brachytherapy. This patient died of a subarachnoid haemorrhage 186 days later. There were three presentations with chest pain during the follow-up period, one associated with scintigraphic abnormality consistent with clinical restenosis. There was no documented angiographic restenosis.

Conclusions: Intracoronary brachytherapy with the Beta-Cath device is simple to apply and has yielded promising intermediate term results in our patient cohort. Its application appears most appropriate to diffuse in-stent restenotic lesions in vessels ranging from 2.5 to 3.5 mm in diameter. In these patients, adjunctive brachytherapy currently provides the best available option for ensuring an enduring result following repeat percutaneous revascularisation.