MedStar Authors catalog › Details for: Intracoronary Brachytherapy for Recurrent Drug-Eluting Stent Failure.
Intracoronary Brachytherapy for Recurrent Drug-Eluting Stent Failure. Journal: JACC. Cardiovascular interventions.Published: 2016ISSN: 1936-8798.UI/PMID: 27339842.Subject(s): Aged | Brachytherapy/ae [Adverse Effects] | *Brachytherapy | Coronary Restenosis/dg [Diagnostic Imaging] | Coronary Restenosis/et [Etiology] | Coronary Restenosis/pp [Physiopathology] | *Coronary Restenosis/th [Therapy] | Coronary Vessels/dg [Diagnostic Imaging] | Coronary Vessels/pp [Physiopathology] | *Coronary Vessels/re [Radiation Effects] | District of Columbia | *Drug-Eluting Stents | Female | Humans | Kaplan-Meier Estimate | Male | Middle Aged | Percutaneous Coronary Intervention/ae [Adverse Effects] | *Percutaneous Coronary Intervention/is [Instrumentation] | *Prosthesis Failure | Recurrence | Registries | Retrospective Studies | Risk Factors | Time Factors | Treatment Outcome | Vascular PatencyInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1016/j.jcin.2016.03.018 (Click here) Abbreviated citation: JACC Cardiovasc Interv. 9(12):1259-65, 2016 Jun 27.Local Holdings: Available online through MWHC library: 2008 - present.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).Abstract: BACKGROUND: Recurrent DES-ISR remains a therapeutic challenge, and VBT has been used selectively in recurrent DES failure.Abstract: 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.Abstract: 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.Abstract: 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.Abstract: Copyright c 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.