HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Erne, P. Articles by Resink, T. Search for Related Content PubMed PubMed Citation Articles by Erne, P. Articles by Resink, T.

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