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Endovascular Brachytherapy: Effect on Acute Inflammatory Response after Percutaneous Femoropopliteal Arterial Interventions¹

¹ From the Departments of Angiology (M.S., W.M., R.M.W., A.C.B., H.R., O.W., E.M.), Medical and Chemical Laboratory Diagnostics (M.E.), and Radiotherapy and Radiobiology (B.P., R.P.), University of Vienna, Medical School, Waehringer Guertel 18–20, A-1090 Vienna, Austria. Received December 13, 2002; revision requested February 27, 2003; final revision received May 8; accepted July 2. Address correspondence to M.S. (e-mail: martin.schillinger@akh-wien.ac.at).

PURPOSE: To investigate whether endovascular brachytherapy diminishes vascular inflammation in response to femoropopliteal percutaneous transluminal angioplasty (PTA) or stent implantation in two double-blind randomized-controlled trials.

MATERIALS AND METHODS: Forty-seven consecutive patients from two double-blind randomized-controlled trials were studied. Patients either underwent femoropopliteal PTA with endovascular gamma irradiation (n = 8) or placebo irradiation (n = 7) or underwent PTA and stent implantation with brachytherapy (n = 15) or placebo irradiation (n = 17). High-sensitivity C-reactive protein (CRP), serum amyloid A (SAA), and fibrinogen levels were measured at baseline and 8, 24, and 48 hours after the intervention. The change of acute phase parameters from baseline to 48 hours after intervention indicated the extent of the inflammatory response and was compared between patients undergoing brachytherapy and those undergoing placebo irradiation. Fisher exact test was used for comparison of categorical data, and nonparametric statistical methods were applied for analysis of continuous data (Mann-Whitney U tests for unpaired data and Friedman analysis for repetitive measurements).

RESULTS: Median patient age was 70 years (interquartile range, 56–74 years); 33 (70%) patients were men and 14 (30%) were women. Clinical characteristics and baseline values of acute phase parameters were similar between groups. A statistically significant increase in CRP, SAA, and fibrinogen values was observed after PTA and stent implantation, both in the patients who underwent brachytherapy and in those who underwent placebo irradiation. Compared with placebo irradiation, however, brachytherapy did not significantly reduce any acute phase parameter from baseline to 8, 24, or 48 hours after the intervention (P > .05 for all comparisons).

CONCLUSION: Endovascular brachytherapy did not diminish early vascular inflammation in response to PTA or stent implantation and even induced a trend toward an increased inflammatory response.

© RSNA, 2004

Index terms: Arteries, extremities • Arteries, femoral, 922.1267, 922.1282, 922.454 • Arteries, grafts and prostheses, 922.1267, 924.1267 • Arteries, popliteal, 924.1267, 924.1282, 924.454 • Arteries, transluminal angioplasty, 922.1282, 922.454, 924.1282, 924.454 • Therapeutic radiology, experimental studies, 92.47, 92.1269