Intracoronary Brachytherapy for Recurrent Drug-Eluting Stent Failure

Smita I. Negi, Rebecca Torguson, Jiaxiang Gai, Sarkis Kiramijyan, Edward Koifman, Rosanna Chan, Pamela Randolph, Augusto Pichard, Lowell F. Satler, Ron Waksman

Research output: Contribution to journalArticlepeer-review

39 Scopus citations

Abstract

Objectives The study sought to report safety and long-term clinical efficacy of intravascular brachytherapy (VBT) for recurrent drug-eluting stent in-stent restenosis (DES-ISR). Background Recurrent DES-ISR remains a therapeutic challenge, and VBT has been used selectively in recurrent DES failure. Methods Patients undergoing VBT for recurrent DES-ISR were enrolled from a percutaneous coronary intervention registry. Clinical, procedural, VBT, and outcome data were collected for DES-ISR treated with radiation. Follow-up was obtained by phone call and clinic visits. Results A total of 186 patients (283 lesions) were included. Mean age was 65 ± 11 years, and 115 (61.8%) were men. Mean time to failure from last failed DES implantation was 450.65 ± 50 days. Majority (95%) had >2 episodes of target lesion revascularization (TLR). Commonest presentation of DES-ISR was unstable angina (68, 30%). All lesions were treated with balloon angioplasty followed by VBT using Beta-Cath system (Best Vascular Inc., Springfield, Virginia) with a dose of 23 to 25 Gy at 2 mm from source center. Radiation was delivered to site of ISR, without procedural adverse events, in 99% cases. Incidence of TLR was 3.3% at 6 months, 12.1% at 1 year, 19.1% at 2 years, and 20.7% at 3 years. No subacute thrombosis event was noted. One patient had late thrombosis during a 3-year follow-up. Conclusions VBT for recurrent DES-ISR is safe, with low recurrence rates at 12 months post-procedure, and can be safely used as an effective short-term strategy. Overtime, there is a gradual attrition in patency requiring repeat intervention.

Original languageEnglish
Pages (from-to)1259-1265
Number of pages7
JournalJACC: Cardiovascular Interventions
Volume9
Issue number12
DOIs
StatePublished - 27 Jun 2016
Externally publishedYes

Keywords

  • brachytherapy
  • drug-eluting stent(s)
  • in-stent restenosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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