Author + information
- S1936879815020476-98c9936e497a419b7a9cc4f2ba4b53b8Jaspreet Singh,
- S1936879815020476-06bf5a7692f01d8db1388b9cb40e082cRaj Doshi,
- S1936879815020476-424c72f2e2aeb2a6cbd3760da51f524aKrishna Patel,
- S1936879815020476-3c8820a61a63b2f0651014459e638d70Evan Shlofmitz,
- S1936879815020476-55abc6a13c193ccc6ec8977c0239581cDonna Baby,
- S1936879815020476-9ec04b07fbbcb5f52ba31cc6b5b0d087Rebecca Sgroi,
- S1936879815020476-ce80ff1c165c98931a5bddbdf71516afOlivia Zukowski,
- S1936879815020476-217bab22e795dc20550a3289d1b3bcf1Rajiv Jauhar,
- S1936879815020476-60d51b6a9da03bf4fc0258fc1c5f2d25Barry Kaplan,
- S1936879815020476-903d61550b52a14ff7a1014aea38416aAvneet Singh and
- S1936879815020476-3193e818e24711c02a66c2f426f2c237Perwaiz Meraj
Intracoronary brachytherapy (ICBT) is an effective treatment for restenosis (ISR) of bare metal stents, but its utilization has waned due to the advent of drug eluting stents (DES). The purpose of this study is to evaluate the predictors of ICBT in preventing ISR in DES.
A retrospective analysis was performed on 211 consecutive patients treated on an IRB approved protocol using ICBT for DES ISR for the last 5 years. All patients received ICBT, after balloon angioplasty, using Sr-90 with a centering balloon and an automated delivery device. A dose of 18.4Gy or 23Gy at 2mm depth was delivered based upon the diameter of the injured vessel. The patients were also divided into 2 groups based on the presence (Group A) or absence (Group B) of clinic restenosis (ISR) post ICBT, and the two groups were compared for baseline characteristics. All patients were followed for MACE for 2 years.
The mean age of patients was 66.7 years. At 1 and 2 years post ICBT, clinical ISR occurred in 17.3% and 25.5% of all patients. At 2 years, cumulative MACE incidence was 31.4% with a TVR of 15.2%. Lesion length and vessel diameter were found to be significantly higher in group A patients (Table 1). All-cause mortality at 1[2.7% vs. 3.4% p=0.549] and 2[2.3% vs. 3.5% p=0.551] years was not significantly different between group A and B patients. Prior CABG was found to be associated with a lower incidence of DES ISR post ICBT (p=0.006,multivariate analysis).
ICBT is a safe and effective therapy for DES ISR. We propose that it should be utilized as first-line therapy. Presence of pre-existing CABG may be a negative predictor for DES ISR post ICBT. This may be due to the larger collateral presence. This study represents the largest single center ICBT registry for DES ISR to date, however more prospective data will be needed to determine the optimal patient for treatment.
|Variables||Re-stenosis (Group A)Mean (95% CI)||NON Re-stenosis (Group B)Mean (95% CI)||p value(Unadjusted)||p value(Adjusted)|
|Lesion Length (mm)||30.63 +/- 18.15||21.66 +/- 7.63||0.039||0.049|
|Vessel Diameter (mm)||3.09 +/- 0.46||2.92 +/- 0.39||0.012||0.016|