Predictors of recurrent in-stent restenosis after beta-radiation: An analysis from the START 40/20 trial.
OBJECTIVE
The purpose of this study was to identify potential predictors, including clinical, procedural, angiographic, and intravascular ultrasound (IVUS) parameters, for recurrent in-stent restenosis (ISR) following beta-radiation 90Strontium/Yttrium (90Sr/Y) in a large multicenter trial.


BACKGROUND
Although adjunct brachytherapy reduces recurrent ISR after primary catheter-based intervention, recurrence of stenosis after brachytherapy still occurs.


METHODS
We analyzed 185 IVUS cohort patients in the STent And Restenosis Therapy (START) 40/20 trial where a 40-mm, 90Sr/Y, radioactive source train was exclusively used for treatment of ISR to be treatable with a 20-mm balloon.


RESULTS
Thirty-nine patients underwent target lesion revascularization. Preliminary univariate analysis showed that age, smoking, balloon/artery ratio, geographic miss, minimum lumen diameter, and diameter stenosis at baseline were associated with target lesion revascularization, while none of IVUS variables were (minimum lumen area, minimum stent area, or residual plaque burden). The multivariate logistic regression analysis showed that younger age, lower balloon/artery ratio, and presence of geographic miss were independent predictors of target lesion revascularization.


CONCLUSIONS
Even with adjunct beta-radiation therapy, initial mechanical optimization, such as appropriate balloon sizing and positioning, may be critical for the prevention of recurrent ISR.
Kaneda
Hideaki
H
Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California 94305, USA.
Honda
Yasuhiro
Y
Morino
Yoshihiro
Y
Lansky
Alexandra J
AJ
Yock
Paul G
PG
Bonan
Raoul
R
Fitzgerald
Peter J
PJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D001610:Beta Particles / Q000627:therapeutic use; D019917:Blood Vessel Prosthesis Implantation; D001918:Brachytherapy; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D023903:Coronary Restenosis / Q000175:diagnosis* / Q000532:radiotherapy / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D012008:Recurrence; D015607:Stents; D013326:Strontium Radioisotopes / Q000627:therapeutic use; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
D019275:Radiopharmaceuticals; D013326:Strontium Radioisotopes; D015021:Yttrium Radioisotopes