title: Poor outcome in patients treated with brachytherapy for diffuse in-stent restenosis. The role of additional stenting despite prolonged antiplatelet therapy.
abstract: BACKGROUND
  Brachytherapy (IBT) has been the first effective treatment of in-stent restenosis (ISR). However, when IBT is associated with additional stenting, high rates of late thrombosis have been observed. Even though prolongation of a double antiplatelet therapy seems to have overcome this problem, studies analyzing whether additional stenting still remains a negative prognostic factor for restenosis are lacking.
  
  
  OBJECTIVE
  To evaluate outcomes of patients treated for ISR with or without additional stenting and IBT followed by prolonged antiplatelet therapy.
  
  
  METHODS
  Seventy-seven consecutive patients treated with beta radiation in 89 lesions with ISR were analyzed according to the need for deploying additional stents: 73 lesions were treated without additional stents (Group 1) and 16 lesions with one or more new stents (Group 2) because of suboptimal results or flow-limiting dissections. Double antiplatelet therapy was administered for 12 months. An angiographic follow-up was scheduled after 6 months. P-values < 0.05 were considered significant.
  
  
  RESULTS
  Restenosis rates were 31.5% (23/73) and 62.5% (10/16) in Group 1 (G1) and Group 2 (G2), respectively (p = 0.02). The two groups did not differ for late vessel thrombosis (8 in G1 and 2 in G2). In G2, high rates of recurrence were observed in the additional stent (6/16, 37.5%; p = 0.02 versus edge restenosis and in old stent recurrence in both G1 and G2).
  
  
  CONCLUSIONS
  The association of additional stenting with brachytherapy in treatment of ISR is characterized by poor outcomes, even if a prolonged antiplatelet therapy has been administered. These results are related to high restenosis rates observed in the additional stent.
authors.affiliation: Emodinamica e Cardiologia Invasiva, Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Dennis
authors.initials: D
authors.lastname: Zavalloni
authors.forename: Marco
authors.initials: M
authors.lastname: Rossi
authors.forename: Guido
authors.initials: G
authors.lastname: Belli
authors.forename: Melania
authors.initials: M
authors.lastname: Scatturin
authors.forename: Emanuela
authors.initials: E
authors.lastname: Morenghi
authors.forename: Federica
authors.initials: F
authors.lastname: Marsico
authors.forename: Giampiero
authors.initials: G
authors.lastname: Catalano
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tosi
authors.forename: Paolo
authors.initials: P
authors.lastname: Pagnotta
authors.forename: Patrizia
authors.initials: P
authors.lastname: Presbitero
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001610:Beta Particles / Q000627:therapeutic use; D001918:Brachytherapy; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors