Repeat intracoronary radiation for recurrent in-stent restenosis in patients who failed intracoronary radiation.
BACKGROUND
Intracoronary radiation therapy (IRT) is the only proven treatment for in-stent restenosis (ISR). It is, however, associated with a significant failure rate. The present study evaluated the outcomes of patients who underwent repeat intracoronary radiation for recurrent ISR.


RESULTS
Fifty-one consecutive patients who failed a previous radiation treatment, presented with angina and angiographic evidence of ISR, and were treated with percutaneous coronary intervention (PCI) and repeat radiation to the same segment were studied. Twenty-five patients were treated with gamma radiation in a dose of 15 Gy, and 26 were treated with beta radiation doses of 18.3 to 23 Gy. The mean cumulative dose for this cohort was 39.5+/-11.9 Gy (range, 29 to 75.6 Gy). The outcomes of those patients were compared with outcomes of 299 patients who also failed initial radiation but were treated with repeat conventional PCI to a previously irradiated segment without repeat radiation. At 9 months after treatment, the repeat-IRT group had lower rates of target lesion revascularization (23.5% versus 54.6%; P<0.001) and major adverse cardiac events, including target vessel revascularization (29.4% versus 61.3%; P<0.001). At 9 months, patients with repeat IRT were free of angiographic and clinical events related to the radiation therapy.


CONCLUSIONS
Repeat gamma or beta radiation to treat failed IRT for ISR after conventional PCI is safe and effective at 9 months and should be considered as a therapeutic option for this difficult patient subset.
Waksman
Ron
R
Washington Hospital Center, 110 Irving St, NW, Suite 4B-1, Washington, DC 20010, USA. ron.waksman@medstar.net
Lew
Robert
R
Ajani
Andrew E
AE
Pichard
Augusto D
AD
Satler
Lowell F
LF
Kent
Kenneth M
KM
Chan
Rosanna
R
White
R Larry
RL
Suddath
William O
WO
Pinnow
Ellen
E
Torguson
Rebecca
R
Dilcher
Christian
C
Wolfram
Roswitha
R
Lindsay
Joseph
J
D000787:Angina Pectoris / Q000209:etiology; D001610:Beta Particles / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D023903:Coronary Restenosis / Q000150:complications / Q000532:radiotherapy*; D018450:Disease Progression; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D005720:Gamma Rays / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012042:Registries / Q000706:statistics & numerical data; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D012449:Safety; D015607:Stents / Q000009:adverse effects*; D017211:Treatment Failure; D016896:Treatment Outcome