Outcomes of Intracoronary Brachytherapy for In-Stent Restenosis
Recommended Citation
Basala TR, Khalid MS, Ser OS, Megaly M, Glogoza M, Strepkos D, Rempakos A, Alexandrou M, Mutlu D, Carvalho P, Peng S, Mastrodemos O, Jalli S, Karacsonyi J, Sandoval Y, Wang Y, Sullivan P, Monyak DJ, Voudris K, Al-Ogaili A, Rangan BV, Burke MN, and Brilakis ES. Outcomes of Intracoronary Brachytherapy for In-Stent Restenosis. Am J Cardiol 2025;244:89-98.
Document Type
Article
Publication Date
6-1-2025
Publication Title
The American journal of cardiology
Abstract
Because of limited alternative options, intracoronary brachytherapy (ICBT) continues to be used for treating in-stent restenosis (ISR). We examined the indications, characteristics, and outcomes of ICBT in consecutive patients who underwent ICBT for ISR between January 2014 and December 2023 at a tertiary care center. During the study period 343 patients underwent ICBT of 502 lesions. The median patient age was 67 [60, 74] years, 73.4% of the patients were men, 77.3% had prior myocardial infarction, and 49.4% had prior coronary artery bypass graft surgery. The most common target vessel was the right coronary artery (38.7%) and 7.37% of lesions were in bypass grafts (33 saphenous vein grafts, 4 arterial grafts). A diffuse ISR pattern was found in 76.2% of lesions. Among the study lesions, 58.0% had 2 stent layers and 20.6% had 3 or more stent layers. Technical success was achieved in 96.1% of lesions. Follow-up was available for all patients with a mean follow-up of 701.5 days. The 3-year incidence of target lesion failure (TLF), target vessel myocardial infarction, and major adverse cardiac events were 36.4%, 17.2%, and 45.6%, respectively. In multivariable analysis, higher brachytherapy radiation dose was associated with a lower risk for TLF (aHR per 10 Gy: 0.73; 95% CI 0.54-0.93; p = 0.048). Repeat ICBT procedures had a higher incidence of TLF over 3 years compared with lesions treated with ICBT for the first time (log-rank test: p = 0.008). In conclusion, the 3-year incidence of TLF after ICBT is 36.4% and was lower with higher radiation dose and higher in lesions retreated with ICBT.
Medical Subject Headings
Humans; Brachytherapy; Male; Female; Aged; Coronary Restenosis; Middle Aged; Retrospective Studies; Treatment Outcome; Stents; Coronary Angiography; Percutaneous Coronary Intervention; Follow-Up Studies
PubMed ID
40157830
ePublication
ePub ahead of print
Volume
244
First Page
89
Last Page
98
