Six-year clinical follow-up after treatment of diffuse in-stent restenosis with cutting balloon angioplasty followed by intracoronary brachytherapy with liquid rhenium-188-filled balloon via transradial approach.
BACKGROUND
Long-term follow-up studies revealed a significant decline in the benefits of intracoronary radiation for in-stent restenosis.


RESULTS
A total of 25 study and 25 contemporaneous control patients with diffuse in-stent restenosis who underwent cutting balloon angioplasty (CBA) transradially, followed by subsequent intracoronary irradiation with a liquid β-emitter Rhenium-188 (¹⁸⁸Re)-filled balloon were enrolled in the study. The mean clinical follow-up durations were 64.9 ± 13.0 and 66.3 ± 13.8 months for the irradiated and control patients, respectively. Six-month angiographic restenosis was observed in 16% (4 of 25) of the patients in the irradiated group and 48% (12 of 25) of the patients in the control groups (P = 0.03). The 6-month major adverse cardiac events (MACE) rate was 12% and 44%, respectively (P = 0.025). The 3-year follow-up angiography was performed in 16 of 21 (76%) irradiated patients and in 4 of 13 (31%) control patients who had no significant restenosis at the 6-month angiographic follow-up. Restenosis occurred in 1 of 16 (7%) irradiated patients and 2 of 4 (50%) control patients. Late target lesion revascularization was performed in 1 irradiated and 2 control patients. The MACE rate within 6 years was significantly reduced in the irradiated group (20% vs. 56%, P = 0.019).


CONCLUSIONS
Brachytherapy using ¹⁸⁸Re-filled balloon following CBA for diffuse in-stent restenotic native coronary arteries is effective in reducing target lesion restenosis and improving long-term outcomes.
Section of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan.
Chi-Ling
CL
Hang
Bor-Tsung
BT
Hsieh
Chiung-Jen
CJ
Wu
Hon-Kan
HK
Yip
Cheng-Hsu
CH
Yang
Shyh-Ming
SM
Chen
Yuan-Kai
YK
Hsieh
Morgan
M
Fu
Sarah
S
Chua
Gary Bih-Fang
GB
Guo
Stephen Wan
SW
Leung
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017534:Radial Artery; D011829:Radiation Dosage; D011868:Radioisotopes / Q000627:therapeutic use*; D012211:Rhenium / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome
D011868:Radioisotopes; D012211:Rhenium