Intracoronary Brachytherapy for Recurrent Drug-Eluting Stent Failure.
Intracoronary Brachytherapy for Recurrent Drug-Eluting Stent Failure.
- 2016
Available online through MWHC library: 2008 - present
BACKGROUND: Recurrent DES-ISR remains a therapeutic challenge, and VBT has been used selectively in recurrent DES failure. 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. Copyright c 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. 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. 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). 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.
English
1936-8798
*Brachytherapy
*Coronary Restenosis/th [Therapy]
*Coronary Vessels/re [Radiation Effects]
*Drug-Eluting Stents
*Percutaneous Coronary Intervention/is [Instrumentation]
*Prosthesis Failure
Aged
Brachytherapy/ae [Adverse Effects]
Coronary Restenosis/dg [Diagnostic Imaging]
Coronary Restenosis/et [Etiology]
Coronary Restenosis/pp [Physiopathology]
Coronary Vessels/dg [Diagnostic Imaging]
Coronary Vessels/pp [Physiopathology]
District of Columbia
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Percutaneous Coronary Intervention/ae [Adverse Effects]
Recurrence
Registries
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Vascular Patency
MedStar Heart & Vascular Institute
Journal Article
Available online through MWHC library: 2008 - present
BACKGROUND: Recurrent DES-ISR remains a therapeutic challenge, and VBT has been used selectively in recurrent DES failure. 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. Copyright c 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. 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. 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). 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.
English
1936-8798
*Brachytherapy
*Coronary Restenosis/th [Therapy]
*Coronary Vessels/re [Radiation Effects]
*Drug-Eluting Stents
*Percutaneous Coronary Intervention/is [Instrumentation]
*Prosthesis Failure
Aged
Brachytherapy/ae [Adverse Effects]
Coronary Restenosis/dg [Diagnostic Imaging]
Coronary Restenosis/et [Etiology]
Coronary Restenosis/pp [Physiopathology]
Coronary Vessels/dg [Diagnostic Imaging]
Coronary Vessels/pp [Physiopathology]
District of Columbia
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Percutaneous Coronary Intervention/ae [Adverse Effects]
Recurrence
Registries
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Vascular Patency
MedStar Heart & Vascular Institute
Journal Article