Brachytherapy for in-stent restenosis in general interventional practice: a single institution's experience using four radiation devices.
BACKGROUND
The effectiveness of brachytherapy for the treatment of in-stent restenosis (ISR) has been established in a number of large randomized controlled trials. Efficacy of this therapy in general population is less well established.


METHODS
We report our experience of 207 patients, 236 coronary lesions, treated with brachytherapy between November 2000 and November 2002. All commercially available brachytherapy devices, as well as one investigational device, were utilized. This cohort was followed over 9 months and clinical outcomes were obtained with subsequent analysis of patient and lesion-specific characteristics.


RESULTS
Average treatment age was 62.5 years; 73% were male and the most frequent presentation was unstable angina (74%). All patients had successful delivery of radiation, with no in-hospital deaths. Novoste BetaCath device was used for 163 (65%) lesions, Cordis Checkmate for 56 (24%) lesions, Interventional Therapies device in 13 (8%) lesions, and Guidant Galileo in 4 lesions (3%). At a mean follow-up of 9.1 months, 78.7% were free of major adverse cardiac event (MACE). Twenty-one patients required repeat PTCA (10.1%), 19 had CABG (9.2%), 3 had MI (1.4%), and there was 1 death (0.5%). Unadjusted MACE rates for each device were 21% for Novoste, 28% for Checkmate, 8% for Interventional Therapies, and 50% for Galileo. Lesion length, minimal lumen diameter, renal failure, diabetes, and smoking did not predict treatment failure; only age was inversely correlated with MACE (P=.002).


CONCLUSIONS
When applied across a spectrum of patients, lesions, and devices, brachytherapy retains its effectiveness with outcomes similar to those reported in randomized clinical trials.
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, P.O. Box 208017, New Haven, CT 06510, USA.
Harsimran S
HS
Singh
Kenneth B
KB
Roberts
Ning
N
Yue
Ravinder
R
Nath
Given Hae-Jun
GH
Song
Nassir
N
Azimi
Steven
S
Pfau
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D001918:Brachytherapy / Q000295:instrumentation*; D003237:Connecticut; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy; D004867:Equipment Design; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome