Intravascular brachytherapy for native coronary ostial in-stent restenotic lesions.
OBJECTIVE
We analyzed the effects of vascular brachytherapy (VBT) on ostial in-stent restenosis (ISR).


BACKGROUND
In-stent restenosis has a high recurrence rate after percutaneous reintervention. The recurrence rate of ostial ISR lesions and the impact of VBT remain unknown.


METHODS
We evaluated 133 patients with native coronary ostial ISR from a pooled database of 990 patients enrolled in randomized VBT trials. Independent quantitative angiography was performed at baseline and follow-up in 45 gamma, 27 beta, and 61 placebo patients.


RESULTS
Binary restenosis was significantly higher in placebo than radiated patients (75.4% vs. 17.8% in gamma vs. 22.2% in beta, p < 0.0001). The treatment effect of both gamma (odds ratio [OR] 0.06; 95% confidence interval [CI] 0.02 to 0.17) and beta VBT (OR 0.10; 95% CI 0.03 to 0.31) was maintained after controlling for differences in baseline lesion length. Proximal and distal radiation edge restenosis rates were similar among the groups. Vascular brachytherapy of true aorto-ostial lesions (n = 34) was similarly beneficial: restenosis rates of placebo versus gamma or beta patients of 83.3% versus 6.7% versus 28.6%, p = 0.0002.


CONCLUSIONS
Conventional treatment of ostial ISR is associated with a recurrence rate of over 75%. Vascular brachytherapy with either gamma or beta sources results in significant and similar reductions in restenosis compared with placebo. Similar benefits after VBT prevail in true aorto-ostial lesions.
Costantini
Costantino O
CO
Cardiovascular Research Foundation, Lenox Hill Hospital, 55 East 59th Street, 6th Floor, New York, New York, NY 10022, USA.
Lansky
Alexandra J
AJ
Mintz
Gary S
GS
Shirai
Kazuyuki
K
Dangas
George
G
Mehran
Roxana
R
Fahy
Martin
M
Slack
Steven
S
Coral
Maria
M
Teirstein
Paul S
PS
Waksman
Ron
R
Stone
Gregg
G
Moses
Jeffrey
J
Leon
Martin B
MB
D001011:Aorta / Q000473:pathology; D001610:Beta Particles / Q000627:therapeutic use; D001918:Brachytherapy; D002932:Cineangiography; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D003331:Coronary Vessels / Q000473:pathology; D005720:Gamma Rays / Q000627:therapeutic use; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015607:Stents