Impact of intracoronary radiation on in-stent restenosis involving ostial lesions.
The aim of this study was to compare 6-month clinical outcomes of patients with in-stent restenosis (ISR) involving the ostium treated with intracoronary radiation therapy (IRT) compared to placebo therapy, and also to nonostial lesions treated with IRT. Coronary interventions in ostial lesions have a high rate of recurrence of restenosis. The impact of IRT on ostial ISR has been inadequately characterized. We assessed patients enrolled in gamma (192-iridium) and beta (90-yttrium, 32-phosphorus) radiation trials for ISR at the Washington Hospital Center. Of patients receiving IRT, 105 (8%) patients had ostial ISR and 1,289 (92%) patients had nonostial ISR. Twenty-seven patients had ostial ISR and received placebo therapy. Baseline demographic and angiographic and procedural details were similar, except ostial IRT patients had a trend toward shorter lesions (15.4 +/- 10.8 vs. 24.1 +/- 12.2 mm; P < 0.001) and had a higher rate of saphenous vein graft disease (46% vs. 19%; P < 0.001) compared to nonostial IRT patients. At 6 months, ostial lesions treated with IRT for ISR had a reduced rate of target lesion revascularization (TLR) compared to ostial lesions treated with placebo (15% vs. 43%; P = 0.004). Outcomes at 6 months were similar for the ostial and nonostial IRT groups including TLR (15% vs. 14%; P = 0.80) and composite major adverse cardiac events (18% vs. 15%; P = 0.46). Intracoronary radiation therapy is effective for ostial in-stent restenotic lesions and should be comfortably used for this challenging anatomic location.
Ajani
Andrew E
AE
Cardiovascular Research Institute, Washington Hospital Center, Washington, DC, USA.
Waksman
Ron
R
Cheneau
Edouard
E
Leborgne
Laurent
L
Pinnow
Ellen
E
Canos
Daniel A
DA
Satler
Lowell F
LF
Pichard
Augusto D
AD
Kent
Kenneth M
KM
Lindsay
Joseph
J
D000368:Aged; D001918:Brachytherapy; D023903:Coronary Restenosis / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010761:Phosphorus Radioisotopes / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
D007496:Iridium Radioisotopes; D010761:Phosphorus Radioisotopes; D015021:Yttrium Radioisotopes