Author + information
- Received December 15, 2015
- Revision received March 7, 2016
- Accepted March 12, 2016
- Published online June 27, 2016.
- Smita I. Negi, MD,
- Rebecca Torguson, MPH,
- Jiaxiang Gai, MSPH,
- Sarkis Kiramijyan, MD,
- Edward Koifman, MD,
- Rosanna Chan, PhD,
- Pamela Randolph, MD,
- Augusto Pichard, MD,
- Lowell F. Satler, MD and
- Ron Waksman, MD∗ ()
- ↵∗Reprint requests and correspondence:
Dr. Ron Waksman, Section of Interventional Cardiology, Department of Medicine, MedStar Washington Hospital Center/Georgetown University, 110 Irving Street Northwest, Suite 4B-1, Washington, DC 20010.
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.
Dr. Waksman has served as a consultant for Abbott Vascular, Biotronik, Boston Scientific, Medtronic, and St. Jude Medical; has served on the Speakers Bureau for AstraZeneca, Boston Scientific, and Merck; and has received research grant support from AstraZeneca, Biotronik, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 15, 2015.
- Revision received March 7, 2016.
- Accepted March 12, 2016.
- American College of Cardiology Foundation