A prospective single-center registry for the use of intracoronary gamma radiation in patients with diffuse in-stent restenosis.
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.
Nikolsky
Eugenia
E
Department of Invasive Cardiology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Rosenblatt
Edward
E
Grenadier
Ehud
E
Boulos
Monther
M
Roguin
Ariel
A
Patil
Chanderashekhar
C
Bernstein
Zvi
Z
Huber
Akiva
A
Ben-Zvi
Margalit
M
Bar-Deroma
Raquel
R
Markiewicz
Walter
W
Beyar
Rafael
R
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D004058:Diffusion; D005260:Female; D005500:Follow-Up Studies; D005720:Gamma Rays / Q000627:therapeutic use*; D006083:Graft Occlusion, Vascular / Q000150:complications / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012086:Reoperation; D012720:Severity of Illness Index; D015607:Stents; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D007496:Iridium Radioisotopes; D019039:Platelet Glycoprotein GPIIb-IIIa Complex