We sought to demonstrate that brachytherapy reduces coronary spasm in refracto ry and highly symptomatic variant angina. In some patients with variant angina d ue to extensive vasoconstriction, intensive drug therapy fails to sufficiently r elieve symptoms. In 18 patients with frequent angina episodes despite triple ant i anginal therapy, coronary spasm was induced by intracoronary acetylcholine (A Ch) infusion. Five patients had spasm in a second vessel. Intracoronary radiatio n(20 Gy) was applied to vasospastic segments using a beta emitting (32P) wire s ource centered within a Galileo balloon. Parameters of vessel function before an d after brachytherapy were investigated. Before brachytherapy, artery diameters decreased(p< 0.0001) from 2.8±0.4 mm to 1.0±0.4 mm for the first vessels and f rom 3.1±0.3 mm to 1.0±0.2 mm for the second vessels. After brachytherapy (143 ±106 and 80±52 days for first and second vessels, respectively), ACh induced vasoconstriction was significantly reduced. The ACh induced changes in artery d iameter before and after brachytherapy were -1.5±0.5 mm and -0.5±0.3mm(p< 0. 0001) for the first vessels and -1.4±0.3 mm and -0.4±0.2 mm (p< 0.01) for th e second vessels, respectively. In non irradiated spastic vessels, ACh induced vasoconstriction remained unchanged (e.g., -1.7±0.6 mm, -1.6±0.3 mm, and - 1.5±0.5 mm for second vessels, at first investigation, first follow up, and im mediately before brachytherapy, respectively). Angina frequency decreased from 1 5.6±6.0 to 2.2±2.4 angina episodes/week(p< 0.001) in treated patients. Brachyt herapy is a potential therapy in patients with highly symptomatic variant angina .
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