TY  - BOOK
AU  - Ben-Dor, Itsik
AU  - Case, Brian C
AU  - Chen, Yuefeng
AU  - Forrestal, Brian J
AU  - Satler, Lowell F
AU  - Shea, Corey
AU  - Torguson, Rebecca
AU  - Waksman, Ron
AU  - Yerasi, Charan
AU  - Zhang, Cheng
TI  - Treatment of Patients With Recurrent Coronary In-stent Restenosis With Failed Intravascular Brachytherapy
SN  - 0002-9149
PY  - 2021///
KW  - *Angioplasty, Balloon, Coronary/mt [Methods]
KW  - *Brachytherapy/mt [Methods]
KW  - *Coronary Restenosis/th [Therapy]
KW  - *Drug-Eluting Stents
KW  - *Percutaneous Coronary Intervention/mt [Methods]
KW  - Aged
KW  - Endovascular Procedures
KW  - Female
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Mortality
KW  - Myocardial Infarction/ep [Epidemiology]
KW  - Myocardial Revascularization/sn [Statistics & Numerical Data]
KW  - Recurrence
KW  - Retreatment
KW  - Treatment Failure
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - 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
UR  - https://dx.doi.org/10.1016/j.amjcard.2020.11.044
ER  -