Comparison of angiographic and clinical outcomes between rotational atherectomy versus balloon angioplasty followed by radiation therapy with a rhenium-188-mercaptoacetyltriglycine-filled balloon in the treatment of diffuse in-stent restenosis.
BACKGROUND
The purpose of this study was to compare the efficacy of rotational atherectomy (RA) with simple balloon angioplasty, prior to beta-radiation therapy with a rhenium-188-mercaptoacetyltriglycine (188Re-MAG3)-filled balloon for diffuse in-stent restenosis (ISR).


METHODS
After completing 50 cases with RA prior to beta-radiation (Group I), we performed optimal balloon angioplasty followed by beta-radiation in the next 53 consecutive patients (Group II) for the treatment of diffuse ISR. The radiation dose was 15 Gy at a depth of 1.0 mm into the vessel wall.


RESULTS
The baseline clinical and angiographic characteristics were similar between the two groups. The mean length of the lesion was 25.6+/-12.7 mm in Group I and 22.9+/-8.6 mm in Group II (p=0.26). Radiation was successfully delivered to all patients, with a mean irradiation time of 179+/-55 s. The 6-month angiographic restenosis rate was 10% (5/50) in Group I versus 33% (17/51) in Group II (p=0.007). No adverse event including myocardial infarction, death, or stent thrombosis occurred during the 1-year follow-up period. The risk of a target lesion revascularization or a major adverse cardiac event was significantly lower in Group I than in Group II (two patients in Group I vs. nine patients in Group II; OR, 0.20; 95% CI, 0.04-0.96; p=0.04).


CONCLUSIONS
Concomitant treatment with rotational atherectomy and beta-irradiation using a 188Re-MAG3-filled balloon for diffuse ISR has a synergistic effect, in terms of 6-month angiographic restenosis and 1-year cardiac event-free survival.
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea.
Seung-Whan
SW
Lee
Seong-Wook
SW
Park
Myeong-Ki
MK
Hong
Jae-Hwan
JH
Lee
Young-Hak
YH
Kim
Dae Hyuk
DH
Moon
Seung Jun
SJ
Oh
Cheol Whan
CW
Lee
Jae-Joong
JJ
Kim
Seung-Jung
SJ
Park
D015906:Angioplasty, Balloon, Coronary; D017225:Atherectomy, Coronary; D001918:Brachytherapy / Q000379:methods*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000627:therapeutic use*; D009942:Organometallic Compounds / Q000627:therapeutic use*; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome
D009842:Oligopeptides; D009942:Organometallic Compounds; C114893:rhenium-mercaptoacetyltriglycine