Long-term clinical and angiographic outcome of patients with occlusive in-stent restenosis treated with (32P) beta-brachytherapy.
The objective of this study was to determine the safety and efficacy of (32)P beta-brachytherapy in totally occlusive in-stent restenosis (ISR). Patients with occlusive ISR were generally excluded from the randomized clinical trials on intracoronary brachytherapy (utilizing either gamma- or beta-sources) that have shown reductions in restenosis rate and need for revascularization procedures. We analyzed short- and long-term effects of (32)P beta-brachytherapy (20 Gy) in 27 patients (28 lesions) with occlusive ISR and 84 (99 lesions) patients with nonocclusive high-risk ISR. The primary outcome measure was frequency of in-lesion angiographic binary restenosis at 7 months. Secondary endpoints were rates of major adverse cardiac events (MACE), target vessel revascularization (TVR), clinically driven TVR, and target lesion revascularization (TLR). (32)P beta-brachytherapy was feasible and safe and provided similar postprocedural angiographic results in the two clinically comparable groups. However, the 7-month binary restenosis rate was higher in the occlusive group, as were the MACE and late total occlusion rates. Multivariate logistic analysis of the overall population indicated occlusive pattern to be the only independent predictor of angiographic restenosis. In both groups, recurrent lesions most often showed a focal pattern with significant reduction of length. Although safe and effective in high-risk ISR, (32)P brachytherapy at 20 Gy does not appear to be sufficient to avoid long-term restenosis in patients with occlusive lesions. Further studies should determine the most suitable source and dosage of brachytherapy for patients with occlusive ISR.
Ortolani
Paolo
P
Institute of Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. paortol@tin.it
Marzocchi
Antonio
A
Aquilina
Matteo
M
Gaiba
William
W
Neri
Stefano
S
Bunkheila
Feisal
F
Lombardo
Enzo
E
Pini
Stefania
S
Marrozzini
Cinzia
C
Palmerini
Tullio
T
Taglieri
Nevio
N
Sbarzaglia
Paolo
P
Reggiani
Maria Letizia Bacchi
ML
Barbieri
Enza
E
Branzi
Angelo
A
D000368:Aged; D001610:Beta Particles / Q000627:therapeutic use; D019917:Blood Vessel Prosthesis Implantation; D001918:Brachytherapy / Q000379:methods; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010761:Phosphorus Radioisotopes / Q000627:therapeutic use*; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D010761:Phosphorus Radioisotopes; D019275:Radiopharmaceuticals