Radiation Therapy May Help Mend a Broken Heart
"Before the stents, I was constantly popping nitroglycerin pills and using nitro patches because of chest pains. I just never bounced back after the angioplasties," Iliff tells WebMD. "Now, it's a whole new ball game. I am an active volunteer fireman, and I can keep up with my grandchildren. I was out shoveling snow yesterday. I can do anything I want to do, and the nitro patches are sitting in back of the closet somewhere."
Even a few years ago the use of coronary stenting was relatively rare, but stents are now used in more than half of the patients undergoing nonsurgical heart procedures such as angioplasty -- where doctors use a balloon-tipped catheter to open clogged coronary arteries.
Like Fred Iliff, many patients who have failed previous coronary interventions do amazingly well after stenting is performed, but around 20% to 30% experience reclogging of the arteries within six months of receiving the procedure. The rate is even higher for patients who receive angioplasty without stents.
But two new studies, published in the Jan. 25 issue of TheNew England Journal of Medicine, suggest that radiation therapy can help keep heart vessel blockage from recurring. The studies come just two months after the FDA approved two devices -- one designed to deliver gamma radiation therapy, the other beta radiation -- to prevent artery reclogging after angioplasty and stenting.
"With the FDA approval last year, and the commercial availability of this treatment coming early next month, it is likely that radiation will be used widely in this group of patients," Jeffrey W. Moses, MD, chief of interventional cardiology at Lenox Hill Cardiovascular Institute of New York, tells WebMD. "We have used radiation in close to 500 patients, and it has proven to be very successful."
Moses and his Lenox Hill colleagues were involved in the Gamma One Trial, a study evaluating the use of coronary gamma-radiation therapy in 131 patients who had renarrowing of the arteries following the implantation of stents. Compared with an equal number of patients with similar symptoms who were not treated with radiation therapy, those receiving gamma radiation had significantly lower rates of artery reclogging. But they also had a higher rate of blood clotting, known as thrombosis, which resulted in more heart attacks. Approximately 10% of the patients who received gamma radiation experienced heart attacks during the follow-up period, compared with 4% of those not given radiation therapy.