title: Comparison of effectiveness and safety of drug-eluting stents versus vascular brachytherapy for saphenous vein graft in-stent restenosis.
abstract: We investigated the safety and efficacy of drug-eluting stents (DESs) for the treatment of patients who presented with in-stent restenosis (ISR) of saphenous vein grafts (SVGs) and compared the in-hospital and 6-month clinical outcomes of DESs with those of intravascular brachytherapy and balloon angioplasty alone. Records of 187 patients who presented with ISR of SVGs were analyzed. Of these, 34 consecutive patients were treated with DES implantation, 93 were treated with intravascular brachytherapy (n = 60 with gamma-radiation, n = 33 with beta-radiation), and 60 patients underwent conventional treatment with balloon angioplasty alone. Clinical and angiographic characteristics at baseline were comparable between groups. The DES group had less non-Q-wave myocardial infarction than did the intravascular brachytherapy and balloon angioplasty groups (0%, 20%, and 26%, p = 0.003 and <0.001, respectively). At 6 months, death occurred in 0% of the DES group, 2% of the intravascular brachytherapy group, and 5% of the balloon angioplasty group (p = 0.36 and <0.18, respectively). Target lesion revascularization/major adverse cardiac events were similar in the intravascular brachytherapy and DES groups (12% and 3%, p = 0.13) and significantly decreased compared with patients who were treated with balloon angioplasty alone (55%, p <0.001 for the 2 comparisons). The results of this retrospective analysis suggest that DES implantation is at least as effective and safe as intravascular brachytherapy for the treatment of SVG ISR and that these treatment modalities are superior to balloon angioplasty alone.
authors.affiliation: The Washington Hospital Center, Washington, DC, USA.
authors.forename: Sundeep
authors.initials: S
authors.lastname: Mishra
authors.forename: Roswitha M
authors.initials: RM
authors.lastname: Wolfram
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: William W
authors.initials: WW
authors.lastname: Chu
authors.forename: Zhenyi
authors.initials: Z
authors.lastname: Xue
authors.forename: Natalie
authors.initials: N
authors.lastname: Gevorkian
authors.forename: Sirisha
authors.initials: S
authors.lastname: Donekal
authors.forename: Rosanna
authors.initials: R
authors.lastname: Chan
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001918:Brachytherapy; D016022:Case-Control Studies; D003326:Coronary Circulation; D016503:Drug Delivery Systems; D005260:Female; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D015607:Stents
chemical_list: D010975:Platelet Aggregation Inhibitors