title: Randomized comparison between intracoronary beta-radiation brachytherapy and implantation of paclitaxel-eluting stents for the treatment of diffuse in-stent restenosis.
abstract: OBJECTIVE
  Intracoronary brachytherapy was the primary therapeutic option for the treatment of in-stent restenosis (ISR) during the last years. Especially for the treatment of diffuse ISR (lesions >10mm), beta-source brachytherapy was significantly superior to singular balloon angioplasty. Despite lacking clinical database, the implantation of drug eluting stents recently became a common procedure for the treatment of ISR. This randomized trial aimed to compare the efficacy of beta-brachytherapy with beta-radioisotopes (90)Sr/(90)Y and paclitaxel-eluting stent implantation for the treatment of diffuse ISR.
  
  
  METHODS
  Thirty-seven patients with diffuse ISR were randomly assigned to beta-brachytherapy after balloon angioplasty (Beta-Cath in 17 patients) or paclitaxel-eluting stent implantation (Taxus-Express2 in 20 patients). Six-month clinical follow-up was obtained for all patients, while angiographic follow-up was available for 30 patients.
  
  
  RESULTS
  Binary ISR (restenosis >50%) within target segment was observed in three patients treated with Beta-Cath, of which one needed target segment revascularisation for recurrent ISR, whereas no significant restenosis occurred in the patients treated with Taxus-Express2 (P=0.037). No further major adverse cardiac (target segment revascularisation, myocardial infarction, death) was found in either group (P=NS). Stent implantation was the more time-saving (31+/-11 min versus 60+/-23 min, P<0.001) procedure.
  
  
  CONCLUSIONS
  Although this trial revealed a significant reduction of binary restenosis in the Taxus-Express2 arm, we found no difference in clinical outcome after implantation of paclitaxel-eluting stents for the treatment of diffuse ISR when compared to beta-brachytherapy.
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria. christoph.schukro@meduniwien.ac.at
authors.forename: Christoph
authors.initials: C
authors.lastname: Schukro
authors.forename: Bonni
authors.initials: B
authors.lastname: Syeda
authors.forename: Christian
authors.initials: C
authors.lastname: Kirisits
authors.forename: Rainer
authors.initials: R
authors.lastname: Schmid
authors.forename: Philipp
authors.initials: P
authors.lastname: Pichler
authors.forename: Boris
authors.initials: B
authors.lastname: Pokrajac
authors.forename: Irene
authors.initials: I
authors.lastname: Lang
authors.forename: Richard
authors.initials: R
authors.lastname: Pötter
authors.forename: Dietmar
authors.initials: D
authors.lastname: Glogar
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D001610:Beta Particles; D001918:Brachytherapy / Q000379:methods*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000628:therapy*; D004333:Drug Administration Routes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D015607:Stents; D016896:Treatment Outcome
chemical_list: D017239:Paclitaxel