title: Late results (>10 years) of intracoronary beta brachytherapy for diffuse in-stent restenosis.
abstract: BACKGROUND
  Until the development of drug-eluting stents (DES), diffuse in-stent restenosis (ISR) was the main limitation of bare-metal stents in percutaneous coronary intervention (PCI). Among the different treatments available, intracoronary brachytherapy (BT) emerged as one of the most promising, although it was almost abandoned with the increasing use of DES.
  
  
  OBJECTIVE
  To assess the Portuguese experience with 90Sr/90Y beta brachytherapy for the treatment of diffuse ISR regarding long-term (>10 years) major adverse cardiac events (MACE) and angiographic restenosis.
  
  
  METHODS
  This single-center, retrospective, observational study included 12 consecutive patients treated between January and June 2001, mean age 58.6±9.9 years (range 43-77 years), 11 male. All had chronic stable angina, 75% had dyslipidemia, 58% had hypertension, 50% had peripheral arterial disease, 42% had diabetes and 50% had multivessel disease. Recurrent ISR was present in half of the patients and 11 had normal left ventricular function. After balloon dilatation, BT was performed using an Sr90/Y90 (Novoste Beta-CathTM) beta radiation source. All patients remained under dual antiplatelet therapy until scheduled nine-month follow-up angiography. Patients were followed for the occurrence of death (all-cause and cardiovascular), non-fatal myocardial infarction (MI), revascularization, stent thrombosis and angiographic restenosis. MACE were defined as the combined incidence of cardiac death, MI and urgent target vessel revascularization.
  
  
  RESULTS
  In all cases there was both clinical and angiographic success. In a mean follow-up of 10.9±2.5 years, 19 events occurred in seven patients: death in three (25%), only one cardiac (8.3%); ST-elevation MI in one (related to a non-target vessel) (8.3%); and 15 revascularizations in five (42%), of which nine were of the target vessel (mainly in the first two years). There was only one case of probable stent thrombosis. Angiographic restenosis at nine months was 27% (three out of 11 patients), of which two were total occlusions. Ten-year MACE-free survival was 42% (5 patients).
  
  
  CONCLUSIONS
  Intracoronary beta brachytherapy for the treatment of diffuse ISR in this small cohort of patients proved to be safe and efficacious, with no late adverse events related to intracoronary radiation.
authors.affiliation: Unidade de Intervenção Cardiovascular (UNICARV), Serviço de Cardiologia, Hospital de Santa Cruz - CHLO, Lisboa, Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Seabra Gomes
authors.affiliation: Unidade de Intervenção Cardiovascular (UNICARV), Serviço de Cardiologia, Hospital de Santa Cruz - CHLO, Lisboa, Portugal; Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal. Electronic address: paraujogoncalves@yahoo.co.uk.
authors.forename: Pedro
authors.initials: P
authors.lastname: de Araújo Gonçalves
authors.affiliation: Unidade de Intervenção Cardiovascular (UNICARV), Serviço de Cardiologia, Hospital de Santa Cruz - CHLO, Lisboa, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Campante Teles
authors.affiliation: Unidade de Intervenção Cardiovascular (UNICARV), Serviço de Cardiologia, Hospital de Santa Cruz - CHLO, Lisboa, Portugal.
authors.forename: Manuel
authors.initials: M
authors.lastname: de Sousa Almeida
mesh_terms: D000328:Adult; D000368:Aged; D001610:Beta Particles / Q000627:therapeutic use*; D001918:Brachytherapy; D023903:Coronary Restenosis / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: Beta radiation; Brachytherapy; Braquiterapia; Coronary disease; Doença coronária; Radiação beta; Restenose; Restenosis