title: Intracoronary beta-brachytherapy in chronic total occlusions: a subgroup analysis from the RENO registry.
abstract: Conventional interventional therapy has been less rewarding in chronic total occlusion (CTO). Brachytherapy by its antiproliferative and positive remodeling effect may be more efficacious. Forty-six centers registered 1,098 consecutive patients undergoing brachytherapy with the BetaCath system. Of these, 78 patients had 82 lesions (CTO) at presentation-the study population. With 67% in-stent CTO, 8% graft CTO, 4% recurrent CTO, long lesions (27.6 +/- 20.9 mm), and 31% diabetes, the cohort had high risk for recurrence. The in-hospital event rate was 1.3%. Six-month follow-up revealed 1.3% death, 5.1% myocardial infarction, 21.8% target vessel revascularization, 77.8% improved angina, 34.5% binary restenosis, 12.7% reocclusion, and 10.3% late thrombosis. The results were comparable to all other patients in the registry, although late thrombosis rate was higher in the CTO group (10.3% vs. 5.0%; P = 0.047). In the in-stent CTO subgroup (n = 52; 66.7%), there was no in-hospital event, no follow-up death or myocardial infarction, restenosis in 35.1%, and reocclusion in 10.8% of patients. In comparison, death or myocardial infarction was significantly higher in de novo CTO subgroup (P = 0.005). Compared to all other in-stent restenosis patients in the registry, the patients with in-stent CTO had similar clinical and angiographic event rate. Thus, beta-brachytherapy was safe, feasible, and effective in this broad population of high-risk patients with CTO presenting in day-to-day practice. It was particularly effective in in-stent CTO, where conventional interventional strategies are disappointing.
authors.affiliation: Medizinische Klinik II, Universitätsklinikum Lübeck, Lübeck, Germany. deepakjain@hotmail.com
authors.forename: Deepak
authors.initials: D
authors.lastname: Jain
authors.forename: Volker
authors.initials: V
authors.lastname: Geist
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Lorenzen
authors.forename: Franz
authors.initials: F
authors.lastname: Hartmann
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: Raoul
authors.initials: R
authors.lastname: Bonan
authors.forename: Philip
authors.initials: P
authors.lastname: Urban
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
mesh_terms: D000368:Aged; D001610:Beta Particles / Q000627:therapeutic use; D001918:Brachytherapy; D002908:Chronic Disease; D015331:Cohort Studies; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000532:radiotherapy*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000532:radiotherapy*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D012720:Severity of Illness Index