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Three‐year follow‐up after intravascular γ‐radiation for in‐stent restenosis in saphenous vein grafts
Author(s) -
Rha SeungWoon,
Kuchulakanti Pramod,
Ajani Andrew E.,
Cheneau Edouard,
Pinnow Ellen E.,
Canos Daniel A.,
Torguson Rebecca,
Pichard Augusto D.,
Satler Lowell F.,
Kent Kenneth M.,
Ramee Steven,
Teirstein Paul,
Lindsay Joseph,
Waksman Ron
Publication year - 2005
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.20372
Subject(s) - medicine , restenosis , mace , stent , atherectomy , percutaneous coronary intervention , angioplasty , neointima , surgery , radiology , target lesion , lesion , cardiology , saphenous vein graft , artery , myocardial infarction
The Washington Radiation for In‐Stent Restenosis Trial in Saphenous Vein Grafts (SVG WRIST) demonstrated safety and efficacy of intravascular radiation therapy (IRT) for the treatment of in‐stent restenosis (ISR) in SVG at 12 months. In this study, we aimed to examine whether the safety and efficacy of IRT is durable up to 36 months. One hundred twenty patients with diffuse ISR in SVG underwent balloon angioplasty, laser or atherectomy ablation, and/or additional stenting. After successful intervention, patients were randomly assigned in a double‐blind fashion to intravascular treatment with a ribbon containing either iridium (Ir)‐192 (n = 60) or nonradioactive seeds (n = 60). The prescribed dose at 2 mm from the source was either 14 or 15 Gy in vessels 2.5–4.0 mm or 18 Gy in vessels > 4.0 mm in diameter. At 36 months, target lesion revascularization (TLR; 43% vs. 66%; P = 0.02) and target lesion revascularization‐major adverse cardiac event (TLR‐MACE; 49% vs. 71%; P = 0.02) rates continued to be lower in the IRT group, but both target vessel revascularization (TVR; 59% vs. 71%; P = 0.17) and TVR‐MACE (63% vs. 77%; P = 0.11) rates were not. In SVG WRIST, patients with ISR treated with IRT had a marked reduction in the need for repeat TLR at 36 months, with sustained clinical benefit at 3 years despite late recurrences, which were more pronounced in the radiation group. © 2005 Wiley‐Liss, Inc.