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INTERVENTIONAL CARDIOLOGY

Brachytherapy: Potential therapy for refractory coronary spasm

Paul Erne, MD^*,*, Peiman Jamshidi, MD^*, Peter Juelke, MD, Hans-Peter Hafner, PhD, Peter Thum, MD and Therese Resink, PhD

^* Cardiology
Radiotherapy, Kantonsspital Luzern, LuzernSwitzerland
Department of Research, Kantonsspital Basel, Basel, Switzerland

Manuscript received May 14, 2004; revised manuscript received June 8, 2004, accepted June 22, 2004.

^* Reprint requests and correspondence: Dr. Paul Erne, Division of Cardiology, Kantonsspital Luzern, 6006 Luzern 16, Switzerland (Email: Paul.Erne{at}KSL.CH).

OBJECTIVES: We sought to demonstrate that brachytherapy reduces coronary spasm in refractory and highly symptomatic variant angina.

BACKGROUND: In some patients with variant angina due to extensive vasoconstriction, intensive drug therapy fails to sufficiently relieve symptoms.

METHODS: In 18 patients with frequent angina episodes despite triple anti-anginal therapy, coronary spasm was induced by intracoronary acetylcholine (ACh) infusion. Five patients had spasm in a second vessel. Intracoronary radiation (20 Gy) was applied to vasospastic segments using a beta-emitting (³²P) wire source centered within a Galileo balloon. Parameters of vessel function before and after brachytherapy were investigated.

RESULTS: Before brachytherapy, artery diameters decreased (p < 0.0001) from 2.8 ± 0.4 mm to 1.0 ± 0.4 mm for the first vessels and from 3.1 ± 0.3 mm to 1.0 ± 0.2 mm for the second vessels. After brachytherapy (143 ± 106 and 80 ± 52 days for first and second vessels, respectively), ACh-induced vasoconstriction was significantly reduced. The ACh-induced changes in artery diameter before and after brachytherapy were –1.5 ± 0.5 mm and –0.5 ± 0.3 mm (p < 0.0001) for the first vessels and –1.4 ± 0.3 mm and –0.4 ± 0.2 mm (p < 0.01) for the second vessels, respectively. In non-irradiated spastic vessels, ACh-induced vasoconstriction remained unchanged (e.g., –1.7 ± 0.6 mm, –1.6 ± 0.3 mm, and –1.5 ± 0.5 mm for second vessels, at first investigation, first follow-up, and immediately before brachytherapy, respectively). Angina frequency decreased from 15.6 ± 6.0 to 2.2 ± 2.4 angina episodes/week (p < 0.001) in treated patients.

CONCLUSIONS: Brachytherapy is a potential therapy in patients with highly symptomatic variant angina.

Abbreviations and Acronyms   ACh = acetylcholine   CFR = coronary flow reserve   +dv/dt = flow acceleration rate   –dv/dt = flow deceleration rate   LAD = left anterior descending