Predictors of 32P beta brachytherapy failure in patients with high-risk in-stent restenosis.
BACKGROUND
The effectiveness of coronary radiation therapy for the treatment of in-stent restenosis (ISR) has been established in several randomized clinical trials. The efficacy of this treatment in the general population is less well established.


METHODS
We report our experience in 118 consecutive patients with nonselected high-risk ISR who had undergone successful percutaneous coronary intervention and brachytherapy with (32)P beta-irradiation and who were prospectively enrolled in a quantitative angiographic and clinical follow-up protocol at 7 months after the index procedure. The aim of this study was to investigate the independent predictor of angiographic restenosis after (32)P brachytherapy treatment.


RESULTS
Of the patients, 28.8% were diabetics. The mean lesion and mean radiated lengths were, respectively, 30.1 +/- 17.2 and 43.8 +/- 16.9 mm. The ISR pattern was diffuse in 96% of the treated lesions; in particular, 22.1% presented an occlusive pattern and 37.1% a proliferative pattern. At follow-up angiographic, restenosis and major adverse cardiac events (MACE) rates were, respectively, 20.8% and 29.6%. The univariate predictors of angiographic restenosis were procedural geographic miss, pattern IV ISR, manual pullback maneuver of the radiation source, preprocedural lesion percentage stenosis and preprocedural lesion MLD. At logistic regression analysis, only geographic miss and pattern IV ISR were independent predictors of post intracoronary radiation therapy (IRT) angiographic restenosis.


CONCLUSIONS
These data indicate that 7-month angiographic restenosis after (32)P IRT in complex patients with ISR is not a frequent event and is predicted mainly by an occlusive lesion at baseline and by procedural geographical miss.
Institute of Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, Bologna 40138, Italy. paortol@tin.it
Paolo
P
Ortolani
Antonio
A
Marzocchi
Matteo
M
Aquilina
William
W
Gaiba
Feisal
F
Bunkheila
Stefano
S
Neri
Enzo
E
Lombardo
Cinzia
C
Marrozzini
Stefania
S
Pini
Nevio
N
Taglieri
Paolo
P
Sbarzaglia
Maria Letizia Bacchi
ML
Reggiani
Enza
E
Barbieri
Angelo
A
Branzi
D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization / Q000379:methods; D010761:Phosphorus Radioisotopes / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome
D010761:Phosphorus Radioisotopes