title: Intracoronary beta-radiation for the treatment of patients at very high risk for recurrence of in-stent restenosis: a single center experience.
abstract: BACKGROUND
  Intracoronary brachytherapy has significantly reduced the recurrence of in-stent restenosis. The aim of this study was to evaluate the feasibility, safety and efficacy of intracoronary beta-radiation in patients at very high risk for recurrence of in-stent restenosis.
  
  
  METHODS
  We analyzed 42 patients with 50 lesions submitted to catheter-based beta-radiation (Beta-Cath System, Novoste Corporation, Norcross, GA, USA) for in-stent restenosis. Thirty-eight lesions were at the second restenosis, 8 at the third, and 4 at the fourth; a diffuse pattern was present in 78%.
  
  
  RESULTS
  Balloon angioplasty was performed for 30 lesions (60%) and the cutting balloon technique for 20 (40%). In 12 lesions further 14 stents had to be deployed (28%). The delivery catheter was successfully positioned in 96% of the procedures. The mean dwell time was 179 +/- 50 s with a radiation dose ranging from 18.4 to 25.3 Gy, depending on the vessel size. A complete angiographic success without coronary dissection and without any additional stenting after radiation delivery was achieved in 86%. At follow-up (7.2 +/- 2.1 months), the overall restenosis rate was 30.4% (14 lesions). A recurrence was detected in 1/11 lesions with initial focal pattern and in 13/39 lesions with initial diffuse pattern. The restenosis rate was higher in patients in whom a geographic miss had occurred (p < 0.05 vs lesions without geographic miss) and in those in whom a new stent had been deployed (p < 0.05 vs lesions treated without a stent).
  
  
  CONCLUSIONS
  Brachytherapy reduces the in-stent restenosis rate in patients who are at very high risk of recurrence. The restenosis pattern, geographic miss and new stent deployment seem to be negative prognostic factors for recurrence of restenosis.
authors.affiliation: U.O. di Emodinamica Istituto Clinico Humanitas Via Manzoni, 56 20089 Rozzano, MI. Patrizia.Presbitero@humanitas.it
authors.forename: Dennis Zavalloni
authors.initials: DZ
authors.lastname: Parenti
authors.forename: Federica
authors.initials: F
authors.lastname: Marsico
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tosi
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Catalano
authors.forename: Luigi
authors.initials: L
authors.lastname: Maiello
authors.forename: Francesco
authors.initials: F
authors.lastname: Milone
authors.forename: Addolorata
authors.initials: A
authors.lastname: Carcagnì
authors.forename: Paolo Giay
authors.initials: PG
authors.lastname: Pron
authors.forename: Roberto
authors.initials: R
authors.lastname: Orecchia
authors.forename: Patrizia
authors.initials: P
authors.lastname: Presbitero
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001610:Beta Particles / Q000627:therapeutic use; D001918:Brachytherapy; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000175:diagnosis / Q000453:epidemiology* / Q000532:radiotherapy*; D023921:Coronary Stenosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome