Effectiveness and determinants of the long-term beta intracoronary brachytherapy results.
BACKGROUND
Effectiveness evaluation and search for the factors determining long-term results of beta intracoronary brachytherapy (ICBT) are of a special importance in an upcoming era of drug-eluting stents usage for a wide range of clinical indications: de novo and in-stent restenosis lesions.


METHODS
One hundred forty eight consecutive patients (59.6+/-9.6 years, 72% men) treated with beta ICBT for in-stent restenosis (ISR) or de novo lesions were studied. There were 135 ISR in 121 patients and 31 de novo lesions in 27 patients. Follow-up coronary angiography was performed in all patients after a mean of 8.9+/-4.5 months. Detailed qualitative and quantitative angiographic analysis of pre-, peri- and postprocedural as well as follow-up angiograms was performed.


RESULTS
Forty five percent of patients treated for de novo lesions were diabetic. Thirty five percent of all targets were located in vessels with a reference vessel diameter <2.5 mm. Furthermore, 77% of ISR lesions were in Class 1 according to the Mehran classification. The mean length of an irradiated segment was 37.6 mm. The overall recurrent restenosis rate was 28.3%. Multivariate analysis revealed that the reference vessel diameter and the presence of edge injury within the proximal 32P source dose-fall off were the only independent predictors of recurrent restenosis after ICBT (OR 0.46; 95%CI 0.24-0.89; p=0.021 and OR 2.55; 95%CI 1.23-5.25; p=0.011, respectively).


CONCLUSIONS
Recurrent restenosis after beta intracoronary brachytherapy treatment is negatively associated with the target vessel size. Presence of edge injury within the proximal 32P source dose-fall increases the frequency of recurrent renarrowing after ICBT. Our results indicate that target vessel size should be taken into account in optimising interventional strategy for ISR treatment: drug eluting stents versus intracoronary brachytherapy. Avoidance of edge injury within the proximal 32P source dose fall-off is strongly recommended while ICBT application.
Witkowski
Adam
A
2nd Catheterization Laboratory, Institute of Cardiology, Warsaw-Anin, Poland.
Kalińczuk
Łukasz
Ł
Chmielak
Zbigniew
Z
Łyczek
Jarosław
J
Pregowski
Jerzy
J
Kawczyńska
Maria
M
Bulski
Wojciech
W
Kulik
Anna
A
Kepka
Cezary
C
Kruk
Mariusz
M
Pszona
Stanisław
S
Rózyłło
Witold
W
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001918:Brachytherapy / Q000379:methods*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome