Debulking for in-stent restenosis in the brachytherapy era: does it still have a role?
Despite the advent of intracoronary brachytherapy, treatment of in-stent restenosis, particularly diffuse in-stent restenosis, remains problematic. Adjunctive debulking prior to brachytherapy may improve long-term outcomes. We review the literature and report our results of a series of patients treated with excimer laser coronary atherectomy along with balloon angioplasty and brachytherapy for in-stent restenosis. We conclude that adjunctive debulking may improve the long-term clinical outcomes of patients with diffuse in-stent restenosis treated with angioplasty and intracoronary radiation. A randomized controlled trial is warranted.
Tuli
Ajay
A
Emory University Hospital, Cardiac Catheterization Laboratory, Suite C430, 1364 Clifton Road N.E., Atlanta, GA 30322, USA.
Subramaniyam
Veerappan
V
Bakir
Stephen
S
Block
Peter C
PC
Crocker
Ian R
IR
D015906:Angioplasty, Balloon, Coronary / Q000639:trends; D019917:Blood Vessel Prosthesis Implantation / Q000639:trends; D001918:Brachytherapy / Q000639:trends*; D023903:Coronary Restenosis / Q000628:therapy*; D006801:Humans; D015607:Stents; D016896:Treatment Outcome