Long-term outcome of patients treated with repeat percutaneous coronary intervention after failure of gamma-brachytherapy for the treatment of in-stent restenosis.
BACKGROUND
Although (192)Ir intracoronary brachytherapy has been demonstrated to dramatically reduce the recurrence of in-stent restenosis, up to 24% of these patients will still require repeat target-vessel revascularization. The short- and long-term outcomes of repeat percutaneous intervention in this population have not been characterized.


RESULTS
Analysis was performed of all patients enrolled in the GAMMA-I and GAMMA-II brachytherapy trials who underwent repeat percutaneous target lesion revascularization (TLR) because of restenosis. Subjects were divided into 2 cohorts: those who had received (192)Ir brachytherapy and those randomized to placebo. Forty-five (17.6%) of a total of 256 patients whose index treatment was intracoronary radiation therapy and 36 (29.8%) of 121 patients whose index treatment was placebo required repeat percutaneous TLR. The mean time to this first TLR was 295+/-206 days in the irradiated group and 202+/-167 days in the placebo group (P=0.03). Acute procedural success occurred in 100% of irradiated patients and 94% of placebo controls (P=0.19). After the first TLR, a subsequent TLR was required in 15 (33.3%) of 45 brachytherapy patients versus 17 (47.2%) of 36 placebo failure patients (P=0.26). There was no significant difference in time to second TLR between the 2 groups. Other long-term major adverse event rates in both groups were comparable to those of other contemporary angioplasty/stenting series.


CONCLUSIONS
In those patients who "fail" (192)Ir intracoronary brachytherapy for in-stent restenosis, treatment with (192)Ir delays the time to first TLR. Additionally, repeat percutaneous intervention in these patients is safe and efficacious in the short term, with acceptable long-term results.
Prpic
Ross
R
Harvard Clinical Research Institute, Boston, Mass 02215, USA. rprpic@hcri.harvard.edu
Teirstein
Paul S
PS
Reilly
John P
JP
Moses
Jeffrey W
JW
Tripuraneni
Prabhakar
P
Lansky
Alexandra J
AJ
Giorgianni
Joseph-Anthony
JA
Jani
Shirish
S
Wong
S Chiu
SC
Fish
R David
RD
Ellis
Stephen
S
Holmes
David R
DR
Kereiakas
Dean
D
Kuntz
Richard E
RE
Leon
Martin B
MB
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001918:Brachytherapy / Q000009:adverse effects*; D015331:Cohort Studies; D023903:Coronary Restenosis / Q000532:radiotherapy* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007496:Iridium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012008:Recurrence; D012086:Reoperation; D015607:Stents / Q000009:adverse effects*; D013995:Time; D016896:Treatment Outcome
D007496:Iridium Radioisotopes