Intracoronary Brachytherapy For In-stent Restenosis Research Articles

Overview of Intracoronary Brachytherapy for in-Stent Restenosis of a Drug-Eluting Stent

Percutaneous coronary intervention with stenting is considered recently as the most common procedure for the treatment of symptomatic coronary. The article reviewed 41 studies published during 1997-2019 on intracoronary brachytherapy for in-stent restenosis of a drug-eluting stent. Intracoronary radiation therapy was finally confirmed in the setting of in-stent restenosis using as adjunctive therapy. Irradiation dose to vessels may result in fibrosis, which can, in turn, cause the late formation of an aneurysm due to the weakness of the vessel wall. Intracoronary brachytherapy is a critical treatment which should not be ignored.

Intracoronary brachytherapy for in-stent restenosis of drug-eluting stents

PurposeGiven the limited salvage options for in-stent restenosis (ISR) of drug-eluting stents (DES), our high-volume cardiac catheterization laboratory has been performing intracoronary brachytherapy (ICBT) in patients with recurrent ISR of DES. This study analyzes their baseline characteristics and assesses the safety/toxicity of ICBT in this high-risk population. Methods and materialsA retrospective analysis of patients treated with ICBT between September 2012 and December 2014 was performed. Patients with ISR twice in a single location were eligible. Procedural complications included vessel dissection, perforation, tamponade, slow/absent blood flow, and vessel closure. Postprocedural events included myocardial infarction, coronary artery bypass graft, congestive heart failure, stroke, bleeding, thrombosis, embolism, dissection, dialysis, or death occurring within 72 hours. A control group of patients with 2 episodes of ISR at 1 location who underwent percutaneous coronary intervention without ICBT was identified. Unpaired t tests and χ2 tests were used to compare the groups. ResultsThere were 134 (78%) patients in the ICBT group with 141 treated lesions and 37 (22%) patients in the control group. There was a high prevalence of hyperlipidemia (>95%), hypertension (>95%), and diabetes (>50%) in both groups. The groups were well-balanced with respect to age, sex, and pre-existing medical conditions, with the exception of previous coronary artery bypass graft being more common the ICBT group. Procedural complication rates were low in the control and ICBT groups (0% vs 4.5%, P = .190). Postprocedural event rates were low (<5%) in both groups. Readmission rate at 30 days was 3.7% in the ICBT group and 5.4% in the control group (P = .649). ConclusionsThis is the largest recent known series looking at ICBT for recurrent ISR of DES. ICBT is a safe treatment option with similarly low rates (<5%) of procedural and postprocedural complications compared with percutaneous coronary intervention alone. This study establishes the safety of ICBT in a high-risk patient cohort.

Establishing the Safety of Intracoronary Brachytherapy for In-Stent Restenosis of Drug-Eluting Stents

Establishing the Safety of Intracoronary Brachytherapy for In-Stent Restenosis of Drug-Eluting Stents

A Renewed Application of Intracoronary Brachytherapy for In-Stent Restenosis of Drug-Eluting Stents

A Renewed Application of Intracoronary Brachytherapy for In-Stent Restenosis of Drug-Eluting Stents

A Renewed Application of Intracoronary Brachytherapy for In-Stent Restenosis at a High-Volume Catheterization Center

A Renewed Application of Intracoronary Brachytherapy for In-Stent Restenosis at a High-Volume Catheterization Center

Drug‐Eluting Stents vs Intracoronary Brachytherapy for In‐Stent Restenosis: A Meta‐Analysis

It has been reported that drug-eluting stents (DES) were superior to intracoronary brachytherapy (ICBT) in patients with in-stent restenosis (ISR). However, it is unknown whether there might be differences between DES and ICBT in terms of efficacy and safety in large sample size and long-term follow-up. The aim of this study was to determine whether DES implantation remains favorable in large sample size and long-term follow-up when compared with ICBT among patients with ISR. We conducted a search in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials without language restrictions. A meta-analysis of 1942 cases from 12 controlled trials of DES vs ICBT for ISR was performed. Drug-eluting stents were significantly more effective in reducing target-vessel revascularization (TVR) (odds ratio [OR]: 0.44, 95% confidence interval [CI]: 0.23-0.81, P = 0.009) and binary restenosis (OR: 0.34, 95% CI: 0.26-0.46, P<0.00001) compared with ICBT at midterm follow-up. There were no significant differences between DES and ICBT in cardiac death, myocardial infarction (MI), and late stent thrombosis at midterm follow-up. A statistical significance has been found between the 2 groups in TVR (OR: 0.61, 95% CI: 0.43-0.86, P = 0.005) at long-term follow-up. There were no significant differences in cardiac death and MI between the 2 groups at long-term follow-up. These findings provide evidence that DES is superior to ICBT for the treatment of ISR in TVR and binary restenosis reduction, but not in cardiac death, MI, and late stent thrombosis reduction. © 2011 Wiley Periodicals, Inc. Yong-Guang Lu, MD, and Yan-Mei Chen, MD, contributed equally to this work. The authors have no funding, financial relationships, or conflicts of interest to disclose.

Implementing a best-treatment strategy with intracoronary brachytherapy for in-stent restenosis in patients at high risk for recurrence

The deployment of drug-eluting stents (DES) to treat bare-metal stent restenosis [in-stent restenosis (ISR)] has become routine practice, with a consequential decline in the use of intracoronary brachytherapy (ICBT). However, there are concerns as to the long-term safety profile of DES, particularly in terms of late stent thrombosis. In addition, an appropriate treatment strategy for stenosis within DES has not been developed. The aim of this study was to examine the efficacy of best treatment with ICBT for ISR in patients at high risk for future recurrence. Forty-seven consecutive patients with symptomatic ISR with at least one or more increased risk criteria for recurrence were treated with beta-radiation. The patients received best treatment based on avoidance of previously reported procedural risk factors for recurrence (incomplete stent apposition, dissection, geographical miss, and damage to the noninjured vessel segment), deferring ICBT when provisional stenting was performed. A beta-radiation dose of 20 Gy was used, and clopidogrel was prescribed for at least 6 months. Treatment was successful for all patients without in-hospital complications. ICBT increased the total intervention procedure time by 15+/-10 min. ISR length was 25.4+/-11.5 mm. The angiographic minimal luminal diameter (MLD) was 2.24+/-0.43 mm after ICBT versus 0.75+/-0.58 mm at baseline (P<.05). On 9-month follow-up, the MLD was 1.93+/-0.48 mm (P<.05 vs. baseline). Binary restenosis was detected in six (13%) patients. At 29.7+/-9.3 months of follow-up, target lesion revascularization or target vessel (nonlesion) revascularization was performed in 17 (36%) patients. Only one patient suffered a myocardial infarction, and no deaths were observed. The adoption of a best-practice protocol for the use of ICBT to treat ISR can result in a safe and effective clinical and angiographic outcome. Under these circumstances and with appropriate patient selection, ICBT may continue to be of value despite the popular use of DES.

300 poster The intracoronary brachytherapy for in-stent restenosis: clinical and film dosimetric results

300 poster The intracoronary brachytherapy for in-stent restenosis: clinical and film dosimetric results

Intracoronary brachytherapy for the prevention of restenosis after percutaneous coronary revascularization

Purpose The purpose of this article is to review the current literature pertaining to intracoronary brachytherapy for the prevention of restenosis after percutaneous coronary revascularization (PCR). Methods English-language articles were identified through a MEDLINE search (January 1984 to January 2003) using the keywords brachytherapy, radioactive stents, and coronary arteries. In addition, pertinent reference citations from relevant articles were reviewed. Results Restenosis after PCR is a complex process, thought to be due to a combination of vessel wall remodeling and neointimal proliferation. To date, catheter-based delivery of intracoronary brachytherapy has been found to prevent vessel wall remodeling and causes a reduction in the proliferation of the neointima. Neointimal proliferation, as measured by mean neointimal area, was reduced in all animal studies (range 26%–91%). In contrast, animal studies examining radioactive stents demonstrated an increase in neointimal proliferation, suggesting that they may not be helpful at preventing post-PCR restenosis. All human studies using catheter-based intracoronary brachytherapy for in-stent restenosis have employed either β (beta) or γ (gamma) radiation sources with variable doses of radiation (range 7–56 Grays [Gy]). Restenosis occurred in 12% to 40% of patients in nonrandomized studies, and clinical events occurred in 13% to 50% of patients. To date, there have been 7 published randomized trials in humans comparing catheter-based intracoronary brachytherapy to placebo, with a total of 1047 patients. The dose of radiation in the trials ranged from 14 Gy to 30 Gy. During follow-up, 8% to 33% of patients who received brachytherapy had restenosis versus 39% to 64% of patients receiving placebo. Clinical events occurred in 19% to 50% among patients who received brachytherapy versus 29% to 79% among patients receiving placebo. The majority of human studies examining radioactive stents do not demonstrate a reduction in restenosis in patients post-PCR. There are no randomized trials examining radioactive stents in humans. Conclusion Nonrandomized studies of radioactive stents suggest they are not effective at preventing in-stent restenosis. In contrast, data from animal and human studies suggest that catheter-based intracoronary brachytherapy can prevent in-stent restenosis and reduce clinical events post-PCR.

Longer sources of intracoronary brachytherapy for in-stent restenosis reduces restenosis in the real world

Longer sources of intracoronary brachytherapy for in-stent restenosis reduces restenosis in the real world

P2221 Short and long-term results of intracoronary brachytherapy for in-stent restenosis in 200 consecutive patients

P2221 Short and long-term results of intracoronary brachytherapy for in-stent restenosis in 200 consecutive patients

Cardiovascular News

Cardiovascular News

Long-term outcome of patients treated with repeat percutaneous coronary intervention after failure of gamma-brachytherapy for the treatment of in-stent restenosis.

Although (192)Ir intracoronary brachytherapy has been demonstrated to dramatically reduce the recurrence of in-stent restenosis, up to 24% of these patients will still require repeat target-vessel revascularization. The short- and long-term outcomes of repeat percutaneous intervention in this population have not been characterized. Analysis was performed of all patients enrolled in the GAMMA-I and GAMMA-II brachytherapy trials who underwent repeat percutaneous target lesion revascularization (TLR) because of restenosis. Subjects were divided into 2 cohorts: those who had received (192)Ir brachytherapy and those randomized to placebo. Forty-five (17.6%) of a total of 256 patients whose index treatment was intracoronary radiation therapy and 36 (29.8%) of 121 patients whose index treatment was placebo required repeat percutaneous TLR. The mean time to this first TLR was 295+/-206 days in the irradiated group and 202+/-167 days in the placebo group (P=0.03). Acute procedural success occurred in 100% of irradiated patients and 94% of placebo controls (P=0.19). After the first TLR, a subsequent TLR was required in 15 (33.3%) of 45 brachytherapy patients versus 17 (47.2%) of 36 placebo failure patients (P=0.26). There was no significant difference in time to second TLR between the 2 groups. Other long-term major adverse event rates in both groups were comparable to those of other contemporary angioplasty/stenting series. In those patients who "fail" (192)Ir intracoronary brachytherapy for in-stent restenosis, treatment with (192)Ir delays the time to first TLR. Additionally, repeat percutaneous intervention in these patients is safe and efficacious in the short term, with acceptable long-term results.

Role of intracoronary brachytherapy for in-stent restenosis?

Role of intracoronary brachytherapy for in-stent restenosis?

Usefulness of intracoronary brachytherapy for in-stent restenosis with a 188Re liquid-filled balloon

The objective of this randomized pilot trial with 21 patients was to evaluate the effectiveness of a rhenium-188 liquid-filled balloon system to prevent recurrent restenosis after percutaneous transluminal coronary angioplasty for in-stent restenosis. A significant benefit from brachytherapy was seen at 6-month repeat angiography, as well as during the clinical follow-up of 12 months.

Late Thrombosis After Radiation

Five years after Condado et al1 first treated human coronary arteries with brachytherapy, there is ongoing clinical investigation into its safety and efficacy in preventing restenosis. As with any novel technique, unexpected complications may dampen early high expectations and result in pessimism and skepticism. However, time, experience, and complete data analysis will determine the reality. Costa and coworkers2 may be reacting prematurely by reporting a new phenomenon in interventional cardiology entitled “late, sudden thrombosis after PTCA plus radiotherapy.” They report 6 (6.6%) of 91 patients who presented with late total occlusion/thrombosis at angiographic follow-up; these patients were enrolled into different radiation protocols using different β-emitters at different prescribed doses. Late total occlusion or late thrombosis is a valid concern, especially when associated with acute myocardial infarction (MI). However, can we really draw any conclusion from 6 heterogeneous case reports taken from a small cohort of patients in the absence of a control group? Is this announcement based on too few data, and is it premature? An editorial based on a Brief Rapid Communication mandates the editorialist to gather additional information, disclose his own insights, and provide the readers (the jury in this case) with as much information as possible. Acute thrombosis occurs during or early after intervention, and subacute thrombosis occurs within the subsequent 30 days. Both usually present with unstable symptoms and angiographic evidence of thrombus. However, the definition of late thrombosis may be problematic. It may not present with symptoms. It may be detected only when follow-up angiography shows a late total occlusion, which could also be the result of progressive intimal hyperplasia. Late total occlusion/thrombosis should be defined as any angiographically documented total occlusion >30 days after the procedure. For patients who have a patent treatment site at 6 months and subsequently develop a total …