title: Intravascular brachytherapy for native coronary ostial in-stent restenotic lesions.
abstract: 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.
authors.affiliation: Cardiovascular Research Foundation, Lenox Hill Hospital, 55 East 59th Street, 6th Floor, New York, New York, NY 10022, USA.
authors.forename: Costantino O
authors.initials: CO
authors.lastname: Costantini
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shirai
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.forename: Steven
authors.initials: S
authors.lastname: Slack
authors.forename: Maria
authors.initials: M
authors.lastname: Coral
authors.forename: Paul S
authors.initials: PS
authors.lastname: Teirstein
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
authors.forename: Gregg
authors.initials: G
authors.lastname: Stone
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Moses
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
mesh_terms: 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