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Angioplasty With Radioactive ‘Seeds' to Treat Heart Disease
Jefferson Physicians Performing Angioplasty With Radioactive ‘Seeds’ to
Treat Heart Disease
Artist’s rendering of the beta-radiation catheter in a blocked
coronary artery. |
When they were first introduced several years ago, tiny metal mesh tubes called stents promised to be a panacea for heart patients. Stents, which are never removed, were going to keep newly cleaned coronary arteries propped open after balloon angioplasty (a procedure during which a balloon at the tip of a catheter is inflated to widen the blocked artery) clearing a path for blood to reach the heart.
An unexpected reaction
But in as many as 20 to 30 percent of cases, the balloons stretch and injure the artery, triggering scar tissue to build up and block blood flow in three to six months. The process, called restenosis, has become the bane of cardiologists.
“We can reopen the blockage with balloons, lasers and rotablators but then the artery tends to close up again within six months,” requiring another procedure, says Michael Savage, MD, Associate Professor of Medicine at Jefferson Medical College of Thomas Jefferson University and Director of the Cardiac Catheterization Laboratory at Thomas Jefferson University Hospital.
Uncovering a solution through clinical trial
In 1998, Thomas Jefferson University Hospital physicians, led by Dr. Savage, David Fischman, MD, Director of Jefferson’s Core Angiography Laboratory in the Division of Cardiology and Associate Professor of Medicine at Jefferson Medical College of Thomas Jefferson University, and Richard Valicenti, MD, Associate Professor of Radiation Oncology at Jefferson Medical College began participating in a clinical trial combining balloon angioplasty and tiny bursts of radiation inside a catheter in the coronary artery – a procedure called brachytherapy – in an attempt to reopen stopped up vessels.
Jefferson was among the first hospitals in the world to perform brachytherapy and was one of 30 centers in the START (Stents and Radiation Therapy) trial that established the effectiveness of this new procedure. The trial compared balloon angioplasty with radiation to angioplasty alone on patients with recurrent blockages after stent placement. Jefferson physicians placed tiny temporary radioactive “seeds” inside the coronary artery immediately after the angioplasty procedure, providing low-dose radiation therapy. Only 14 percent of patients treated with radiation had restenosis inside the stent compared to 41 percent of patients who did not receive radiation. The former also had fewer follow-up procedures, such as bypass or another angioplasty.
Radiation works over 3 to 4 minutes. Patients leave the hospital in less than 24 hours.
Jefferson physicians use a system called the Beta-Cath TM System made by Novoste Corporation in Norcross, Ga., to deliver the radiation.
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