Leakage of a liquid 188Re-filled balloon system during intracoronary brachytherapy. A case report
Introduction
An investigational method for intracoronary radiation therapy uses a liquid solution of β-emitting rhenium-188 as sodium perrhenate-188 (NaReO4, 188Re) to inflate a modified angioplasty-type balloon catheter [1], [2], [3]. 188Re is a high energy β-emitter with a 15% γ-ray emission and with a physical half-life of 17.0 h. Because the balloon inflation pressures used are four standard deviations below the mean burst pressure for this system, the probability of balloon rupture is estimated to be less than 1 in 30,000 treatments. Never the less, in the event of balloon leakage the isotope would be released into the bloodstream resulting in internal radiation dose to all organs of the body. The dose received depends on how much activity is released, how it is distributed among various organs and tissues of the body, and how rapidly it is eliminated.
We report the first case of a radioactive catheter leakage with 188Re resulting in low level exposure in one patient and discuss the safety concerns for using this type of device.
Section snippets
Coronary intervention
In January 1999, an 84-year-old male patient was admitted with rest angina eight months after placement of two AVE GFX stents for a severe proximal LAD stenosis. Coronary angiography showed >90% proximal LAD in-stent restenosis with a length of 25 mm. Balloon angioplasty was performed with a 3.0 diameter balloon at 12 atm. The patient was enrolled into an FDA IDE pilot trial for intracoronary brachytherapy using the liquid 188Re-filled balloon system Radiant® (Vascular Therapies, CA). Prior to
Discussion
We are reporting the first patient receiving intracoronary brachytherapy with intravascular leakage of a liquid 188Re-filled balloon system. The balloon catheter did not rupture, but released approximately one-tenth of the inflated balloon contents. This incident was detected immediately and an appropriate medical treatment was initiated.
Despite the increasing use of various chemical forms of 188Re in therapeutic nuclear medicine [1], [6], [7], little has been published regarding the
Acknowledgements
We thank Donna Earley, Andrea Ravard and Steve Carlson (all Department of Radiation and Environment Safety, Cedars-Sinai Medical Center) for their help, assistance and care in study realization and patient safety.
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