Deleterious Effect of Coronary Brachytherapy on Vasomotor Response to Exercise

作者：Mario Togni, Stephan Windecker, Peter Wenaweser, David Tueller, Abudukadier Kaisaier, Willibald Maier, Bernhard Meier, Otto Martin Hess · 发表于：Circulation · 年份：2004 · DOI：10.1161/01.cir.0000134956.96543.4f · 被引用次数：24 · 研究领域：Coronary Interventions and Diagnostics、Chemotherapy-induced cardiotoxicity and mitigation、Cardiovascular Health and Disease Prevention

BACKGROUND: Intracoronary radiotherapy (brachytherapy) has been proposed as treatment option for in-stent restenosis. Long-term results of brachytherapy with regard to vascular integrity and vasomotor responsiveness are unknown. The purpose of the present study was to determine the vasomotor response after brachytherapy and to assess its influence on vasomotion during exercise. METHODS AND RESULTS: Biplane quantitative coronary angiography was performed at rest and during bicycle exercise in 27 patients with coronary artery disease. Fourteen patients underwent coronary stenting and were studied 10+/-3 months after intervention (control group). Thirteen patients were treated with brachytherapy (Guidant Galileo System) for in-stent restenosis with a mean dosis of 20 Gy at 1 mm into the vessel wall and were studied 9+/-1 months after radiation (brachytherapy group). Minimal luminal area, stent area, and proximal, distal, and a reference vessel area were determined. The reference vessel showed exercise-induced vasodilation (26+/-4%, P<0.001) in both groups. Vasomotion within the stented vessel segments was abolished. In control subjects, the proximal and distal segments showed exercise-induced vasodilation (17+/-2% and 22+/-7%, respectively; P<0.005). In contrast, there was exercise-induced vasoconstriction in the proximal and distal vessel segments of the brachytherapy group (-14+/-3% and -16+/-4%, respectively; P<0.01). Sublingual nitroglycerin was associated with maximal vasod...