title: Clinical outcome of patients undergoing low aggressive angioplasty combined with brachytherapy and short-term dual antiplatelet therapy for in-stent restenosis.
abstract: OBJECTIVE
  The impact of vessel injury on the outcome of patients undergoing percutaneous coronary intervention combined with brachytherapy for in-stent restenosis is under investigation. We report our clinical experience adopting a low aggressive balloon angioplasty technique, to limit vessel trauma, associated with brachytherapy and short-term dual antiplatelet therapy.
  
  
  METHODS
  Forty-nine consecutive patients, undergoing percutaneous coronary intervention with brachytherapy for symptomatic in-stent restenosis, were prospectively observed for a median time of 21 + or - 8 months. Clinical follow-up included anginal status, death, myocardial infarction and repeat revascularization; only patients with evidence of ischaemia repeated coronary angiography. Low aggressive angioplasty consisted in the use of a conventional balloon with a balloon to artery ratio < or = 1, avoiding high inflation pressures and the use of other devices. Dual antiplatelet therapy was continued for 3-6 months.
  
  
  RESULTS
  Early angiographic result was good and the need for additional stent implantation was low (3.9%). At follow-up, we did not observe death, acute myocardial infarction or stent thrombosis, but 10 patients repeated coronary angiography for recurrence of ischaemia: disease progression was present in two cases (4.1%). Restenosis emerged in the remaining eight patients (16.3%): two cases showed restenosis within the target lesion segment, one case within the injured segment, one case within the radiated segment, and four cases at the edges. The consequent new revascularization was surgical in three patients and percutaneous in seven patients.
  
  
  CONCLUSIONS
  Our data suggest that low aggressive angioplasty followed by brachytherapy and short-term dual antiplatelet therapy for in-stent restenosis is related to a good outcome, with a low restenosis rate and without stent thrombosis.
authors.affiliation: Cardiovascular Department, Umberto I Hospital, Mestre (VE), Italy. francesco.dipede@ulss12.ve.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Pede
authors.forename: Paolo
authors.initials: P
authors.lastname: Buja
authors.forename: Paolo
authors.initials: P
authors.lastname: Millosevich
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Grassi
authors.forename: Massimo
authors.initials: M
authors.lastname: Celestre
authors.forename: Guerrino
authors.initials: G
authors.lastname: Zuin
authors.forename: Cristina
authors.initials: C
authors.lastname: Marchetti
authors.forename: Gianbeppi
authors.initials: G
authors.lastname: Pizzi
authors.forename: Michele
authors.initials: M
authors.lastname: Antonello
authors.forename: Luca
authors.initials: L
authors.lastname: Bindoni
authors.forename: Antonio
authors.initials: A
authors.lastname: Raviele
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001918:Brachytherapy / Q000379:methods*; D003131:Combined Modality Therapy; D017023:Coronary Angiography / Q000379:methods; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011446:Prospective Studies; D011475:Prosthesis Failure; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors