Durable clinical benefit following Sr90 Beta irradiation therapy for in-stent restenosis in high-volume community practice.
Although randomized clinical trials have demonstrated efficacy of coronary irradiation versus placebo for the treatment of in-stent restenosis (ISR), durable long-term benefit in community practice is less well defined. From January 1, 2001, through June 30, 2002, consecutive percutaneous coronary intervention (n = 3,869) were analyzed at our center with a total of 330 patients undergoing coronary irradiation for ISR (53, Ir192; 12, P32; 265 Novoste  Sr90). Novoste  Sr90 was successfully performed in 265 of 270 (98%) of patients attempted by 10 operators. The mean patient age was 63 years (range 35 90) with 55% male (145/265) and 45% female (120/265). ISR anatomic subsets included multi-lesion (45/265; 17%), multi-vessel (27/265; 10.0%) and saphenous vein graft (16/265; 6.0%) interventions. At a mean follow-up of 10.5   2.8 (SD) months, fifty-three (20%) of the Novoste Sr90 treated patients had returned for symptoms requiring repeat angiography. Of these, 23 patients had repeat percutaneous coronary intervention (PCI) including 2 target site revascularizations (TSR), twelve non-TSR (distinct from the radiated segment of the target vessel), and 9 non-target vessel revascularizations (TVR). Coronary artery bypass surgery was performed in 11 total patients, 4 due to TSR, and 7 due to non-TVR. Clinical TSR was 2.3% (6/265) and TVR was 6.8% (18/265). In conclusion, the Novoste SR90 Beta-Cath  System for the treatment of ISR is associated with a high procedural success rate and low TSR and TVR. Revascularization in follow-up is predominantly due to progressive disease outside the radiated segment and aggressive secondary prevention, especially prolonged anti-platelet therapy, appear critical to long-term procedural success.
Young
John J
JJ
The Carl and Edith Lindner Center for Research and Education, the Ohio Heart Health Center and the Christ Hospital, Cincinnati, OH 45219, USA. lindner@fuse.net
Marcus
Daniel P
DP
Abbottsmith
Charles W
CW
Broderick
Thomas M
TM
Choo
Joseph K
JK
Runyon
John Paul
JP
Schneider
John F
JF
Shimshak
Thomas M
TM
Geier
Rodney P
RP
Kereiakes
Dean J
DJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001610:Beta Particles / Q000627:therapeutic use*; D003153:Community Health Services; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D011859:Radiography; D015607:Stents / Q000009:adverse effects; D013326:Strontium Radioisotopes / Q000627:therapeutic use*; D016896:Treatment Outcome
D013326:Strontium Radioisotopes