Poor outcome in patients treated with brachytherapy for diffuse in-stent restenosis. The role of additional stenting despite prolonged antiplatelet therapy.
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.
Zavalloni
Dennis
D
Emodinamica e Cardiologia Invasiva, Istituto Clinico Humanitas, Milan, Italy.
Rossi
Marco
M
Belli
Guido
G
Scatturin
Melania
M
Morenghi
Emanuela
E
Marsico
Federica
F
Catalano
Giampiero
G
Tosi
Giovanni
G
Pagnotta
Paolo
P
Presbitero
Patrizia
P
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
D010975:Platelet Aggregation Inhibitors