Intravascular Brachytherapy for the Management of Repeated Multimetal-Layered Drug-Eluting Coronary Stent Restenosis

Abstract

Background: Because of the widespread acceptance of percutaneous coronary intervention with drug-eluting stents as an effective treatment strategy for in-stent restenosis, it is common to encounter multimetal layer stent restenosis in the recent years. This study aimed to evaluate the clinical outcomes of such patients treated with intravascular brachytherapy (IVBT) in comparison with other percutaneous options. Methods and Results: We enrolled patients who underwent percutaneous coronary intervention during the period between 2011 and 2015 for recurrent drug-eluting stents in-stent restenosis with at least 2 layers of stents at the lesion site. This analysis compared patients who underwent treatment with IVBT and those who did not (non-IVBT group). The primary end point measured was major adverse cardiac events defined as a composite of target lesion revascularization, myocardial infarction, and all-cause mortality at 12 months. Adjusted associations were measured using propensity score matching. A total of 328 percutaneous coronary intervention patients met the eligibility criteria, of which 197 patients received IVBT, and 131 patients underwent routine percutaneous intervention. The primary end point was significantly lower in patients undergoing IVBT (13.2% and 28.2%; P =0.01). A propensity score matching for risk factors of in-stent restenosis identified 182 patients. The advantages of IVBT with regard to 1-year major adverse cardiac events were confirmed in this matched cohort (13.2% and 30.8%; adjusted hazard ratio [95% CI]: 0.37 [0.18–0.73]; P <0.01). Conclusions: In this analysis, IVBT led to significantly lower major adverse cardiac events in patients with multilayered drug-eluting stents restenosis when compared with other percutaneous options at 1-year follow-up.

Outcomes of intravascular brachytherapy for recurrent drug‐eluting in‐stent restenosis

“…In contrast to the study by Yabushita et al 28 (Table S10). [8][9][10] Our results are consistent with the outcomes of those studies with an incidence of target lesion/vessel revascularization of 30-40% at 2-3 years, highlighting the high risk of repeat failure after VBT. We also found that the initial presentation with ACS was independently associated with TLF.…”

“…Varghese et al demonstrated that using VBT in recurrent DES‐ISR was associated with lower major adverse cardiac events compared with other therapies at 1 year 10 . Despite the classic description of focal restenosis with DES‐ISR, a higher percentage of recurrent DES‐ISR lesions had diffuse ISR as described in our cohort and by Mangione et al 8 …”

“…Of multiple treatment options, such as balloon angioplasty (BA), 6 drug‐coated balloons (DCB), 7 or repeat DES implantation, vascular brachytherapy (VBT) can inhibit neointimal growth without antiproliferative drugs or additional metal layers. There are limited data, however, on the use of brachytherapy for recurrent DES‐ISR 8–10 . We report a large, single‐center experience on long‐term outcomes after VBT for recurrent DES‐ISR.…”

“…There are limited data, however, on the use of brachytherapy for recurrent DES-ISR. [8][9][10] We report a large, single-center experience on long-term outcomes after VBT for recurrent DES-ISR.…”

Comparison of drug-eluting balloon with repeat drug-eluting stent for recurrent drug-eluting stent in-stent restenosis

“…Varghese et al . [17] reported that in patients with recurrent DES-ISR treated by new-generation DES repeat deployment, the rates of 1-year MACE and TLR were 30.8% and 24.2%, respectively. These were similar to the adverse event rates for the Re-DES group in our study.…”