Comparison between drug-eluting stents and beta-radiation for the treatment of diffuse in-stent restenosis: clinical and angiographic outcomes.
BACKGROUND
Initial reports on drug-eluting stents (DES) for the treatment for in-stent restenosis (ISR) show very good outcomes. Nevertheless, few data are available on direct comparison with intracoronary brachytherapy (IBT). The aim of this study was to compare brachytherapy and DES in treatment of diffuse ISR.


METHODS
One hundred forty-one consecutive patients with diffuse ISR were treated with IBT (68 patients; beta (90Sr/90Y) emitters) or with DES (73 patients; 32 with sirolimus-eluting and 41 with paclitaxel-eluting stents). Angiographic and clinical follow-up was scheduled within 9 months.


RESULTS
The first 74 lesions were treated with IBT (group 1) and the latter 74 with DES (group 2). The two groups were well matched for clinical/angiographic characteristics. At follow-up, restenosis rates were 37.8% (28/74) in IBT group and 14.9% (11/74) in DES group (P = .0028). A diffuse pattern of recurrence was more frequent after IBT (20/74 vs 6/74, P = .005). A worse outcome after IBT was associated with the "edge effect," accounting for most failures. Recurrence within the original restenotic stent was similar in both groups (12.9% vs 14.9% in groups 1 and 2 respectively, P = .8).


CONCLUSIONS
Drug-eluting stents are more effective than IBT with beta-irradiation in reducing recurrence rates after treatment of diffuse ISR. In case of failure, the pattern of restenosis is more benign after treatment with DES.
Zavalloni
Dennis
D
U.O. Emodinamica e Cardiologia Invasiva, Istituto Clinico Humanitas, Milan, Italy.
Belli
Guido
G
Rossi
Marco L
ML
Scatturin
Melania
M
Morenghi
Emanuela
E
Catalano
Gianpiero
G
Tosi
Giovanni
G
Gasparini
Gabriele L
GL
Pagnotta
Paolo
P
Presbitero
Patrizia
P
D000368:Aged; D001610:Beta Particles / Q000627:therapeutic use*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D001918:Brachytherapy; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000532:radiotherapy*; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents
D007166:Immunosuppressive Agents; D017239:Paclitaxel; D020123:Sirolimus