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Investigation of a New Device to Improve Dosimetric Outcomes in Intravascular Brachytherapy

      Coronary artery disease is amongst the main causes of death in developed countries. Percutaneous Transluminal Coronary Angioplasty (PTCA or angioplasty) is a procedure used to open stenoted (narrowed) arteries. Restenosis (renarrowing) of the treated vessel is a major complication of PTCA. A metal mesh tube (stent) is expanded inside the vessel to prevent restenosis. Tissue stress incurred during angioplasty and stenting can provoke rapid proliferation of neointimal cells leading to in stent restenosis (ISR). Intravascular brachytherapy (IVBT), a form of internal radiotherapy, is used to treat ISR. Renewed interest in IVBT is being expressed as a treatment for patients with ISR in Drug Eluting Stents. Existing catheter based intravascular brachytherapy devices use a guidewire that is mounted on the outside of the delivery catheter. This has been shown to reduce the dose to target tissue behind the guidewire by as much as 35% from Sr-90/Y-90 based devices. If IVBT seeds with a hollow center were developed such that a guidewire could run interior to the seeds we hypothesize that localized dose reductions from guidewires in IVBT should vanish. Treatment times may also be reduced when using IVBT devices with a guidewire in the center because the radioisotope can be placed closer to the edge of the delivery catheter which should increase the dose delivered per particle to the target arterial walls. The activity of a source can be increased by increasing the total amount of active core material in each seed. Cylindrical shell seeds should be able to carry more active material than seeds currently used in IVBT because area scales with r2. Each of these factors motivates the investigation of IVBT devices with cylindrical shell seeds and interior guidewires. We perform a dosimetric analysis to evaluate the viability of one such device.
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