Friday, June 17, 202210:00 AM - 12 PMPO01: Intravascular Brachytherapy of the Coronary Arteries for In Stent In Stent Restenosis: Sicker Patients, but Just as Safe

Abstract

<h3>Purpose</h3> More than 20 years ago prophylactic intravascular brachytherapy burst into the radiation oncology lexicon, only to be replaced within a few years by the introduction of drug eluting stents. However, restenosis still occurs in 5- 15% of high risk patients with two or more layers of drug eluting stents. We examined our experience in patients with in stent in stent restenosis who have no options for durable revascularization and therefore are forced to lead a shortened and sedentary life, comparing this to our historic control group. <h3>Materials and Methods</h3> A retrospective cohort of 134 patients treated with angioplasty followed by intracoronary brachytherapy was compared to a current high risk group of 122 patients with in stent in stent restenosis. All patients had a minimum 6 month follow up post brachytherapy. None of the original cohort had stenting performed at the time of brachytherapy, while all patients in the restenosis cohort had placement of at least 2 layers of intracoronary stents prior to repeat angioplasty and IVBT. <h3>Results</h3> In the original cohort, there were no intraprocedural deaths, while the high risk cohort had a single intraprocedural death due to intracoronary thrombosis. No high risk patient developed any significant cardiovascular event otherwise at 6 months post-procedure. <h3>Conclusions</h3> Intravascular brachytherapy for in stent in stent restenosis is equally safe compared to the historic post angioplasty IBVT safety profile, despite the fragile nature and relatively high risk disease status of these patients with limited options.