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Sex-Based Differences in Long-Term Outcomes Following Intravascular Brachytherapy for In-Stent Restenosis.

Mangesh Kritya1, Chloe Kharsa1, Gal Sella1

  • 1Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.

Journal of the Society for Cardiovascular Angiography & Interventions
|April 1, 2026
PubMed
Summary

Women undergoing intravascular brachytherapy (IVBT) for in-stent restenosis (ISR) face higher risks of target lesion revascularization and major adverse cardiovascular events. This highlights the need for sex-specific risk assessments in IVBT treatment strategies.

Keywords:
in-stent restenosisintravascular brachytherapypercutaneous coronary interventionsex-based differences

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • In-stent restenosis (ISR) is a significant complication after percutaneous coronary intervention.
  • Intravascular brachytherapy (IVBT) is an established treatment for ISR.
  • Limited data exist regarding sex-specific outcomes following IVBT.

Purpose of the Study:

  • To investigate sex-based differences in outcomes after IVBT for ISR.
  • To identify if female sex is associated with increased risks of adverse cardiovascular events post-IVBT.

Main Methods:

  • Retrospective, single-center cohort study of 223 patients (61 women, 162 men) treated with IVBT for ISR (2014-2023).
  • Primary end points included all-cause mortality, target lesion revascularization (TLR), and major adverse cardiovascular events (MACE).
  • Multivariable Cox regression analysis was employed to adjust for clinical and procedural factors.

Main Results:

  • Procedural success rates were similar between men and women.
  • Female sex was independently associated with a higher risk of TLR (aHR, 1.80) and MACE (aHR, 1.63).
  • Women also exhibited a significantly higher risk of myocardial infarction (aHR, 2.58), but not all-cause mortality or heart failure hospitalization.

Conclusions:

  • Despite similar procedural success, women treated with IVBT for ISR experience worse cardiovascular outcomes.
  • Findings emphasize the necessity for sex-stratified risk assessment in IVBT.
  • Further prospective research is crucial to elucidate and address sex-based disparities in IVBT outcomes.