When Peoria real estate broker Cathy Ostermeier, 62, was diagnosed with coronary artery disease two years ago, she had an angioplasty—a treatment that thousands of heart patients have each year. But then, to combat future restenosis or renarrowing of her artery, she had an additional new treatment.

Ms. Ostermeier’s interventional cardiologist, Richard R. Heuser, M.D., Director of Research for St. Luke’s Medical Center, explains that while the balloon and stent restore the free flow of vital blood to the heart, in doing so they injure the inside lining of the artery and spur the growth of scar tissue over the wound. Cells grow rapidly through the stent’s steel mesh, sometimes reblocking the artery and requiring another angioplasty or bypass surgery for many patients. What has made recovery unique for Ms. Ostermeier was that her treatment didn’t involve scalpels and sutures, but a material typically used to treat cancer patients—radiation.

“It’s safe and significantly reduces renarrowing. In some cases, there is no evidence at all of the scar tissue we usually see after placing a stent,” says Dr. Heuser, who is leading a clinical trial of the procedure at St. Luke’s Medical Center and who has treated about 50 patients with radiation. More than 6,000 patients worldwide have received the treatment, which is expected to be approved by the FDA this year.

In the procedure, a small balloon guided through a tube device known as a catheter is inflated to unclog the obstructed artery. Then, a stent—a small, cylindrical, steel support—is implanted in the artery to keep it open. After placing the stent, Dr. Heuser steps aside to allow a radiation oncologist with a syringe-like device to push radioactive “seeds” through the catheter to the internal wall of the artery around the stent. After about 5 minutes, the temporary seeds are withdrawn from the body. The procedure can be done at the time of the initial balloon angioplasty, as in Ms. Ostermeier’s case, or when signs of restonosis, such as chest pain, show up months after the angioplasty.

At eight months after the procedure, patients undergo ultrasound imaging and thallium stress testing to measure blood flow through the artery and determine whether reblockage has occurred. According to Dr. Heuser, if patients don’t experience restenosis by that time, their arteries usually remain clear.

According to the results of Novoste Corporation’s recent in-stent restenosis trial of nearly 500 patients, which Dr. Heuser presented at the national conference of the American College of Cardiology in March, renarrowing in stents was reduced by 66 percent in patients who underwent the radiation therapy. The START (Stents and Radiation Therapy) trial also showed a 34 percent reduction in repeat revascularization procedures like angioplasty, and a 31 percent reduction of repeat cardiac events, like heart attacks. Ms. Ostermeier, who no longer experiences the chest pains and shortness of breath that took her to Dr. Heuser in the first place, is relieved that she had the treatment.

Richard R. Heuser has experience using beta radiation to keep problem arteries flowing. Here he displays a unique infrared tipped caheter designed to find minute opennings that were totally occluded.

“The symptoms have disappeared,” says Ms. Ostermeier. “When I went back again and Dr. Heuser said the blood was flowing freely, he was really happy with that.”

Noting that there was no indication of thrombosis, or clotting, in any of the patients who received radiation therapy, Dr. Heuser says, “We couldn’t have asked for a better result from the study.” Dr. Heuser, who has done many of the initial trials of stents in this country, adds “The gist of it is, if I have patients with in-stent restenosis, there’s only one way to treat them—beta radiation.”

Dr. Heuser, who trained at Johns Hopkins and worked with heart surgeons Michael DeBakey and Denton Cooley at Methodist Hospital in Houston, notes that while many cardiologists are interested in the therapy, some are concerned when they hear the word “radiation,” associating it with gamma rays, the most powerful form of radiation. But because the procedure uses a small amount of the less potent beta radiation that penetrates only a few millimeters of the artery, radiation exposure is minimal to the patient, as well as the doctors and nurses.

“Once the devices are through the approval process with the FDA, cardiologists will feel more comfortable with the therapy,” says Dr. Heuser. “In 1999, there were 150,000 patients treated for in-stent restenosis. The majority of cardiologists are going to want to treat those patients with radiation.”

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