A prospective single‐center registry for the use of intracoronary gamma radiation in patients with diffuse in‐stent restenosis

Abstract

Based on single-center prospective registry data, the study evaluates short- and long-term results of intracoronary gamma radiation in patients with diffuse in-stent restenosis in the reality of routine clinical practice. Percutaneous coronary intervention and subsequent catheter-based irradiation with iridium-192 was performed in 84 vessels (81 patients) with diffuse in-stent restenosis. Repeat coronary angiography was performed in 35 patients with clinical restenosis. With a mean follow-up of 12.0 +/- 0.5 months, major adverse cardiac events were observed in 29 (34.5%) patients, including 2 cases of cardiac death, 3 myocardial infarctions, 21 target lesion revascularizations, and 4 target vessel revascularizations. Five of six patients with total occlusion of the target vessel at baseline developed target lesion restenosis. Late total occlusion of the target vessel was observed in four patients. The 1-year event-free survival rate was 69.8%. Total occlusion of the target vessel at baseline was the single independent predictor of cardiac events at 1-year follow-up (P < 0.001). In patients with a target lesion in the left anterior descending artery, predictors of cardiac events also included female sex (P = 0.014), current smoking (P = 0.014), stenting during brachytherapy session (P = 0.02), and smaller reference vessel diameter at baseline (P = 0.01). The results of our registry are similar to those of randomized trials. As applied in routine clinical practice, intracoronary gamma radiation is a feasible, safe, and effective tool in the treatment of diffuse in-stent restenosis. Late events in the entire group were predicted by total occlusion at baseline.

Clinical Results of Intracoronary Brachytherapy (ICBT) for Multiple In-Stent Restenosis

“…However, after a follow-up of 3 years the TVR rate was only 17% (placebo 3%) [1]. Despite loss of efficacy over time, most studies show that ICBT significantly improves the outcome of patients treated for ISR over several years [1,4,5,9,12,19,31,32,36]. The results of our study support the observation of above-cited studies that a long follow-up period is necessary to evaluate the effectiveness of revascularization methods.…”

Chronic total occlusion due to diffuse in‐stent restenosis: is brachytherapy the solution?

“…These studies have documented a reduction of about 50% in restenosis rates and clinical events in patients treated with intracoronary radiation compared with placebo at 6-12 months' follow-up, with the bene®ts being maintained at ®ve years. 4 The results of the present prospective registry 5 provided results similar to those of randomized trials and showed that in routine clinical practice, intracoronary gamma radiation is an effective tool for the treatment of diffuse in-stent restenosis. Percutaneous coronary intervention of chronic total occlusions (CTO) is associated with a signi®cantly higher incidence of reocclusion and restenosis compared with non-total occlusions.…”

Long‐term clinical and angiographic outcome of patients with occlusive in‐stent restenosis treated with (32P) β‐brachytherapy

“…In the mixed population of the RENO multicenter registry (78% of the patients had ISR) [10], chronically occluded lesions appeared to have a higher propensity to develop recurrent total occlusion during follow-up after ␤-IRT. In a single-center study regarding ␥-IRT in the treatment of diffuse ISR lesions, Nikolsky et al [11] found that at 1 year of clinical follow-up, total occlusion at baseline appeared to be the single independent predictor of cardiac events.…”