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Published on: May 14, 2013
Intracoronary brachytherapy for treatment of in-stent restenosis
Mohammad A Saleem1, Wilbert S Aronow, Gowtham Ravipati
1Department of Medicine, Cardiology Division, and the Department of Radiation Medicine, Westchester Medical Center/New York Medical College, Valhalla, New York 10595, USA.
Insights
Intracoronary brachytherapy effectively reduces adverse events in patients with in-stent restenosis. This treatment is beneficial across various patient groups and lesion types, with long-term dual antiplatelet therapy recommended.
Area of Science:
- Cardiology
- Interventional Cardiology
- Radiation Oncology
Background:
- In-stent restenosis (ISR) is a significant complication following coronary artery stenting.
- Effective treatment strategies for ISR are crucial for improving long-term patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of intracoronary brachytherapy (ICBT) compared to placebo in managing in-stent restenosis.
- To identify specific patient subgroups and lesion characteristics where ICBT demonstrates particular benefit.
Main Methods:
- Systematic review and analysis of randomized, double-blind, placebo-controlled trials.
- Assessment of outcomes including death, myocardial infarction, and target vessel revascularization.
Main Results:
- Intracoronary brachytherapy significantly reduces death, myocardial infarction, and target vessel revascularization in patients with in-stent restenosis.
- ICBT is effective for various ISR presentations, including totally occluded lesions, saphenous vein graft lesions, diffuse ISR, ostial lesions, and in high-risk or diabetic patients.
- Both beta and gamma brachytherapy show comparable efficacy for ISR.
Conclusions:
- Intracoronary brachytherapy is a proven and effective treatment for in-stent restenosis across a broad spectrum of clinical scenarios.
- Adherence to long-term aspirin and clopidogrel therapy for at least one year is recommended to mitigate late vessel thrombosis.
- Careful radiation delivery is essential to avoid complications such as edge stenosis.
Abstract:
Randomized, double-blind, placebo-controlled trials have demonstrated that intracoronary brachytherapy is more efficacious than placebo in reducing death, myocardial infarction, and target vessel revascularization at long-term follow up of patients with in-stent restenosis. Intracoronary brachytherapy is efficacious in treating totally occluded in-stent restenotic lesions, in treating de novo and in-stent restenotic lesions in saphenous vein grafts, in treating diffuse in-stent restenosis, in treating native coronary ostial in-stent restenotic lesions, in treating patients with diabetes with in-stent restenosis, in treating patients at high-risk for recurrence of restenosis, in treating elderly patients, and in treating patients who failed intracoronary radiation. Beta and gamma intracoronary brachytherapy are equally effective in treating in-stent restenosis. Long-term aspirin and clopidogrel should be administered for at least 1 year to reduce late vessel thrombosis. Inadequate radiation may cause edge stenosis.
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