Intracoronary brachytherapy following drug-eluting stent failure. It's still not time to hang up the spikes!
Drug-eluting stents (DES) have significantly reduced the incidence of restenosis. Although the results obtained with these novel antiproliferative devices are encouraging, recent reports have shown that DES are not completely immune from restenosis. Therefore, the broad use of DES has inevitably led to a major issue: treatment of DES failure. Intracoronary brachytherapy (IBT) represents an important advancement for treatment of in-stent restenosis (ISR) and has led to important pathophysiological insight on the restenotic process. To date, IBT, when properly used, still represents the gold standard for treatment of ISR. However, experience with IBT is for treatment of ISR occurring with bare metal stents (BMS). Whether IBT may be used with the same safety and efficacy profile as an adjunctive treatment for ISR following DES implantation is still unknown. In this article, we report the outcome of a series of patients with DES failure treated with IBT. IBT for treatment of DES failure was shown to be both safe and efficient and, therefore, until ISR exists, IBT still remains an important player in this growing and even more challenging setting.
Interventional Cardiology Unit, San Carlos University Hospital-planta 2N, Plaza Cristo Rey s/n, 28040 Madrid, Spain.
Dominick J
DJ
Angiolillo
Manel
M
Sabaté
Pilar
P
Jiménez-Quevedo
Fernando
F
Alfonso
Carmen
C
Galván
José Miguel
JM
Fernández
Rosana
R
Hernandez-Antolin
Javier
J
Escaned
Camino
C
Bañuelos
Raul
R
Moreno
Carlos
C
Macaya
D000328:Adult; D000368:Aged; D001918:Brachytherapy; D023903:Coronary Restenosis / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000532:radiotherapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D019233:Retreatment; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents; D017211:Treatment Failure
D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus