Five-year follow-up after intracoronary gamma radiation therapy for in-stent restenosis.
BACKGROUND
The Washington Radiation for In-Stent Restenosis Trial is a double-blinded randomized study evaluating the effects of intracoronary radiation therapy (IRT) in patients with in-stent restenosis (ISR).


RESULTS
One hundred thirty patients with ISR (100 native coronary and 30 vein grafts) underwent percutaneous transluminal coronary angioplasty, laser ablation, rotational atherectomy, or additional stenting (36% of lesions). Patients were randomized to either 192-Iridium IRT or placebo, with a prescribed dose of 15 Gy to a 2-mm radial distance from the center of the source. Angiographic restenosis (27% versus 56%, P=0.002) and target vessel revascularization (26% versus 68%, P<0.001) were reduced at 6 months in patients treated with IRT. Between 6 and 60 months, patients treated with IRT compared with placebo had more target lesion revascularization (IRT, 21.6% versus placebo, 4.7%; P=0.04) and target vessel revascularization (IRT, 21.5% versus placebo, 6.1%; P=0.03). At 5 years, the major adverse cardiac event rate was significantly reduced with IRT (46.2% versus 69.2%, P=0.008).


CONCLUSIONS
In the Washington Radiation for In-Stent Restenosis Trial, patients with ISR treated with IRT using 192-Iridium had a reduction in the need for repeat target lesion and vessel revascularization at 6 months and 5 years.
Waksman
Ron
R
Washington Hospital Center, 110 Irving St NW, Suite 4B-1, Washington, DC 20010, USA. ron.waksman@medstar.net
Ajani
Andrew E
AE
White
R Lawrence
RL
Chan
Rosanna
R
Bass
Bill
B
Pichard
Augusto D
AD
Satler
Lowell F
LF
Kent
Kenneth M
KM
Torguson
Rebecca
R
Deible
Regina
R
Pinnow
Ellen
E
Lindsay
Joseph
J
D006328:Cardiac Catheterization; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000175:diagnosis / Q000209:etiology / Q000532:radiotherapy*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005720:Gamma Rays / Q000009:adverse effects / Q000627:therapeutic use*; D006321:Heart / Q000528:radiation effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000453:epidemiology