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Long‐term clinical and angiographic outcome of patients with occlusive in‐stent restenosis treated with ( 32 P) β‐brachytherapy
Author(s) -
Ortolani Paolo,
Marzocchi Antonio,
Aquilina Matteo,
Gaiba William,
Neri Stefano,
Bunkheila Feisal,
Lombardo Enzo,
Pini Stefania,
Marrozzini Cinzia,
Palmerini Tullio,
Taglieri Nevio,
Sbarzaglia Paolo,
Reggiani Maria Letizia Bacchi,
Barbieri Enza,
Branzi Angelo
Publication year - 2004
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.20298
Subject(s) - medicine , restenosis , mace , brachytherapy , radiology , target lesion , revascularization , stent , cardiology , surgery , myocardial infarction , radiation therapy , conventional pci , percutaneous coronary intervention
The objective of this study was to determine the safety and efficacy of 32 P β‐brachytherapy in totally occlusive in‐stent restenosis (ISR). Patients with occlusive ISR were generally excluded from the randomized clinical trials on intracoronary brachytherapy (utilizing either γ‐ or β‐sources) that have shown reductions in restenosis rate and need for revascularization procedures. We analyzed short‐ and long‐term effects of 32 P β‐brachytherapy (20 Gy) in 27 patients (28 lesions) with occlusive ISR and 84 (99 lesions) patients with nonocclusive high‐risk ISR. The primary outcome measure was frequency of in‐lesion angiographic binary restenosis at 7 months. Secondary endpoints were rates of major adverse cardiac events (MACE), target vessel revascularization (TVR), clinically driven TVR, and target lesion revascularization (TLR). 32 P β‐brachytherapy was feasible and safe and provided similar postprocedural angiographic results in the two clinically comparable groups. However, the 7‐month binary restenosis rate was higher in the occlusive group, as were the MACE and late total occlusion rates. Multivariate logistic analysis of the overall population indicated occlusive pattern to be the only independent predictor of angiographic restenosis. In both groups, recurrent lesions most often showed a focal pattern with significant reduction of length. Although safe and effective in high‐risk ISR, 32 P brachytherapy at 20 Gy does not appear to be sufficient to avoid long‐term restenosis in patients with occlusive lesions. Further studies should determine the most suitable source and dosage of brachytherapy for patients with occlusive ISR. Catheter Cardiovasc Interv 2004;63:433–438. © 2004 Wiley‐Liss, Inc.