Intracoronary brachytherapy for treatment of in-stent restenosis.
Randomized, double-blind, placebo-controlled trials have demonstrated that intracoronary brachytherapy is more efficacious than placebo in reducing death, myocardial infarction, and target vessel revascularization at long-term follow up of patients with in-stent restenosis. Intracoronary brachytherapy is efficacious in treating totally occluded in-stent restenotic lesions, in treating de novo and in-stent restenotic lesions in saphenous vein grafts, in treating diffuse in-stent restenosis, in treating native coronary ostial in-stent restenotic lesions, in treating patients with diabetes with in-stent restenosis, in treating patients at high-risk for recurrence of restenosis, in treating elderly patients, and in treating patients who failed intracoronary radiation. Beta and gamma intracoronary brachytherapy are equally effective in treating in-stent restenosis. Long-term aspirin and clopidogrel should be administered for at least 1 year to reduce late vessel thrombosis. Inadequate radiation may cause edge stenosis.
Saleem
Mohammad A
MA
Department of Medicine, Cardiology Division, and the Department of Radiation Medicine, Westchester Medical Center/New York Medical College, Valhalla, New York 10595, USA.
Aronow
Wilbert S
WS
Ravipati
Gowtham
G
Moorthy
Chitti R
CR
Singh
Suraj
S
Agarwal
Nikhil
N
Monsen
Craig E
CE
Pucillo
Anthony L
AL
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D001918:Brachytherapy / Q000379:methods*; D018849:Controlled Clinical Trials as Topic; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D008297:Male; D015641:Radiography, Interventional / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014654:Vascular Patency / Q000502:physiology
D007496:Iridium Radioisotopes