title: The outcome of percutaneous coronary intervention in patients with in-stent restenosis who failed intracoronary radiation therapy.
abstract: OBJECTIVE
  This study reports the outcome of patients who failed intracoronary radiation therapy (IRT) for the treatment of in-stent restenosis (ISR).
  
  
  BACKGROUND
  Intracoronary radiation therapy has demonstrated a reduction in the recurrence rate of restenosis for patients with ISR. However, 10% to 30% of these patients require repeat intervention to the irradiated site.
  
  
  METHODS
  Of 961 patients who were assigned to gamma or beta radiation for the treatment of diffuse ISR, we evaluated the outcome of 282 (29%) consecutive patients who failed IRT and compared them with the 679 (71%) patients who had successful IRT. For patients who failed radiation, the mean time to the first target vessel revascularization (TVR) was 173 +/- 127 days after the index procedure and the total duration of follow-up was 494 +/- 304 days.
  
  
  RESULTS
  Patients who failed IRT were younger (60 +/- 10 vs. 63 +/- 11 years, p = 0.002) and had a higher incidence of restenting (51% vs. 41%, p = 0.003). The majority (55%) of the restenotic lesions after IRT failure were focal (< or =10 mm), with a mean lesion length of 11.9 +/- 1.9 mm. Of the 257 patients who had subsequent TVR after failed IRT, 68 (26%) underwent coronary artery bypass grafting and 189 (74%) underwent percutaneous coronary intervention using balloon in 61%, restenting in 26%, atheroablation in 11%, and the cutting balloon in 2% of cases. At six months, 6% of patients died, 1% had Q-wave MI, 17% had repeat TVR, and the overall rate of major adverse cardiac events was 21%.
  
  
  CONCLUSIONS
  The predominant angiographic pattern of lesions in patients who failed IRT is focal restenosis, with these lesions responding well to conventional revascularization methods.
authors.affiliation: Division of Cardiology, Washington Hospital Center, 110 Irving Street NW, Washington, D.C. 20010, USA.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Ajani
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
authors.forename: Edouard
authors.initials: E
authors.lastname: Cheneau
authors.forename: Dong-Hun
authors.initials: DH
authors.lastname: Cha
authors.forename: Scott
authors.initials: S
authors.lastname: McGlynn
authors.forename: Marco
authors.initials: M
authors.lastname: Castagna
authors.forename: Rosanna C
authors.initials: RC
authors.lastname: Chan
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Ellen
authors.initials: E
authors.lastname: Pinnow
authors.forename: Joe
authors.initials: J
authors.lastname: Lindsay
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019233:Retreatment; D012189:Retrospective Studies; D013997:Time Factors