Gamma brachytherapy for the treatment of in-stent restenosis of renal arteries

Ron Waksman, Pramod K. Kuchulakanti, John R. Laird, Robert Dieter, Rebecca Torguson, Roswitha Wolfram, Rosanna Chan, R. Larry White, Donna Whitman

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Purpose. The incidence of in-stent restenosis (ISR) after renal artery stenting is 12 to 21%, yet there is no standard treatment method for this problem. Our aim was to assess the safety and efficacy of gamma brachytherapy (g-BT) for the treatment of ISR in renal arteries. Materials and Methods. Eleven patients who presented with renal ISR from January 2003 to March 2004, documented by selective renal angiography, were assigned to treatment with g-BT using Ir-192, followed by balloon angioplasty, laser or re-stenting. Patients were followed clinically at 1, 3, 6, and 9 months, and duplex ultrasound was conducted at 9 months. Results. All patients were hypertensive and on a mean of 2.3 antihypertensive medications. Mean age was 64 ± 8.68 years, 45.5% were males, 36.4% had diabetes mellitus, and 64% were smokers. The mean RVD was 5.4 ± 0.58 mm. The prescribed dose of radiation was 22.8 ± 0.6 Gy, with a dwell time 30.25 ± 1.92 minutes, and was well-tolerated by all patients. Procedural success was 100% and free of complications. Clinical follow-up was available in all patients, and duplex ultrasound in 10 patients. No significant changes in blood urea nitrogen, serum creatinine, creatinine clearance, or the number of antihypertensive medications were observed at follow-up. One patient (9.1%) required target lesion revascularization at 9 months. Conclusion. Gamma brachytherapy as adjunct therapy for the treatment of renal artery ISR appears safe and feasible. However, the clinical benefit of this therapy has to be proven in a large, randomized clinical trial.

Original languageEnglish (US)
Pages (from-to)178-183
Number of pages6
JournalVascular Disease Management
Volume3
Issue number1
StatePublished - Jan 2006
Externally publishedYes

Keywords

  • Gamma radiation
  • In-stent restenosis
  • Renal angioplasty

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Waksman, R., Kuchulakanti, P. K., Laird, J. R., Dieter, R., Torguson, R., Wolfram, R., Chan, R., White, R. L., & Whitman, D. (2006). Gamma brachytherapy for the treatment of in-stent restenosis of renal arteries. Vascular Disease Management, 3(1), 178-183.