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Treatment of Patients With Recurrent Coronary In-stent Restenosis With Failed Intravascular Brachytherapy.

by Ben-Dor, Itsik; Case, Brian C; Chen, Yuefeng; Forrestal, Brian J; Satler, Lowell F; Shea, Corey; Torguson, Rebecca; Waksman, Ron; Yerasi, Charan; Zhang, Cheng.
Citation: American Journal of Cardiology. 142:44-51, 2021 03 01.; .Journal: The American journal of cardiology.Published: 2021; ; ; ISSN: 0002-9149.Full author list: Ben-Dor I; Case BC; Chen Y; Forrestal BJ; Satler LF; Shea C; Torguson R; Waksman R; Yerasi C; Zhang C.UI/PMID: 33285089.Subject(s): *Angioplasty, Balloon, Coronary/mt [Methods] | *Brachytherapy/mt [Methods] | *Coronary Restenosis/th [Therapy] | *Drug-Eluting Stents | *Percutaneous Coronary Intervention/mt [Methods] | Aged | Endovascular Procedures | Female | Humans | Male | Middle Aged | Mortality | Myocardial Infarction/ep [Epidemiology] | Myocardial Revascularization/sn [Statistics & Numerical Data] | Recurrence | Retreatment | Treatment FailureInstitution(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.amjcard.2020.11.044 (Click here) Abbreviated citation: Am J Cardiol. 142:44-51, 2021 03 01; .Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006.Abstract: Intravascular brachytherapy (VBT) is an effective and safe treatment option for recurrent drug-eluting stent (DES) in-stent restenosis (ISR). However, the optimal therapy for patients with failed VBT is not well-defined. In this study, we sought to evaluate the optimal treatment strategy for patients after a failed VBT. Patients with recurrent ISR after an initial unsuccessful VBT were identified from our percutaneous coronary intervention database. Patients were divided into 2 cohorts (standard treatment with DES or balloon angioplasty vs. repeat VBT). Baseline characteristics and clinical outcomes during follow-up were extracted. A total of 279 patients underwent PCI after an initial unsuccessful VBT at our institution. Of those, 215 (77%) patients underwent standard treatment with balloon angioplasty with or without DES, and 64 (33%) underwent balloon angioplasty followed by repeat VBT. The mean age of the cohort was 64+/-11 years. Overall, 71% were men, 47% had diabetes, and 22% had heart failure. The majority (64%) presented with unstable angina. The groups had similar baseline characteristics. The rate of major adverse cardiovascular events (MACE, defined as all-cause mortality, myocardial infarction, or target vessel revascularization) was significantly lower in the repeat VBT group at 1 year (31% vs. 14%, p=0.03), 2 years (51% vs. 31%, p=0.03), and 3 years (57% vs 41%, p=0.08). Target lesion revascularization and target vessel revascularization were consistently lower in the repeat VBT group at all follow-up intervals than in the standard treatment group. Treatment of recalcitrant ISR following an initial failed VBT is associated with a high MACE rate at 3-year follow-up. Repeat VBT is safe and effective and should be considered as the preferred strategy. Copyright (c) 2020. Published by Elsevier Inc.

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