title: Intracoronary Brachytherapy for Recurrent Drug-Eluting Stent Failure.
abstract: The study sought to report safety and long-term clinical efficacy of intravascular brachytherapy (VBT) for recurrent drug-eluting stent in-stent restenosis (DES-ISR).
  
  
  
  Recurrent DES-ISR remains a therapeutic challenge, and VBT has been used selectively in recurrent DES failure.
  
  
  
  Patients undergoing VBT for recurrent DES-ISR were enrolled from a percutaneous coronary intervention registry. Clinical, procedural, VBT, and outcome data were collected for DES-ISR treated with radiation. Follow-up was obtained by phone call and clinic visits.
  
  
  
  A total of 186 patients (283 lesions) were included. Mean age was 65 ± 11 years, and 115 (61.8%) were men. Mean time to failure from last failed DES implantation was 450.65 ± 50 days. Majority (95%) had >2 episodes of target lesion revascularization (TLR). Commonest presentation of DES-ISR was unstable angina (68, 30%). All lesions were treated with balloon angioplasty followed by VBT using Beta-Cath system (Best Vascular Inc., Springfield, Virginia) with a dose of 23 to 25 Gy at 2 mm from source center. Radiation was delivered to site of ISR, without procedural adverse events, in 99% cases. Incidence of TLR was 3.3% at 6 months, 12.1% at 1 year, 19.1% at 2 years, and 20.7% at 3 years. No subacute thrombosis event was noted. One patient had late thrombosis during a 3-year follow-up.
  
  
  
  VBT for recurrent DES-ISR is safe, with low recurrence rates at 12 months post-procedure, and can be safely used as an effective short-term strategy. Overtime, there is a gradual attrition in patency requiring repeat intervention.
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Smita I
authors.initials: SI
authors.lastname: Negi
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Jiaxiang
authors.initials: J
authors.lastname: Gai
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Sarkis
authors.initials: S
authors.lastname: Kiramijyan
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Edward
authors.initials: E
authors.lastname: Koifman
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Chan
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Pamela
authors.initials: P
authors.lastname: Randolph
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Augusto
authors.initials: A
authors.lastname: Pichard
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.affiliation: Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000528:radiation effects*; D004219:District of Columbia; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011475:Prosthesis Failure; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: brachytherapy; drug-eluting stent(s); in-stent restenosis