Abstract 18530: Outcomes of Intracoronary Vascular Brachytherapy for Treatment of In-stent Restenosis in the Contemporary Drug-Eluting Stent Era

    loading  Checking for direct PDF access through Ovid

Abstract

Introduction: In-stent restenosis (ISR) of drug-eluting stents (DES) continues to be a therapeutic challenge and its frequency increases over time. Intracoronary vascular brachytherapy (VBT) was initially approved for treatment of bare-metal stent ISR but its main indication is now for recurrent DES-ISR. The aim of this study was to compare the efficacy of VBT to repeat DES and conventional balloon angioplasty (CBA) for treatment of DES-ISR in the contemporary DES era.

Methods: We performed a retrospective analysis of patients undergoing treatment for DES-ISR from 2003 to 2016. The patients were divided based on treatment of ISR: CBA, DES, or VBT.

Results: 1,137 patients were treated for DES-ISR. 329 (29%) were treated with CBA, 524 (46%) were treated with DES, and 284 (25%) with VBT. The VBT group had higher incidence of prior bypass surgery (56% vs 36% and 34% in the CBA and DES group, respectively, p<0.001). The CBA group had a higher incidence of heart failure (24% vs 19% and 13% in the DES and VBT group, respectively, p=0.003). There was no difference in presentation of unstable angina (58%). Patients treated with CBA or DES presented with myocardial infarction (MI) more than the VBT group (11% for both vs 4%, p<0.001). However, the VBT group had significantly more complex lesions (44% Type C vs 34% and 30% in the CBA and DES groups, p<0.001). One-year rate of composite death, Q-wave MI, and target lesion revascularization were similar for the DES and VBT groups (15% and 16%, respectively) but higher in the CBA group (30%, p<0.001). Rates of stent thrombosis were low (0% in CBA, 0.2% in DES, and 0.4% in VBT, p=0.733).

Conclusions: DES-ISR remains a therapeutic challenge in the contemporary DES era. Treatment of ISR with VBT out-performs CBA and is comparable to repeat DES at one year. VBT should be considered for treatment of ISR, especially for patients not suitable for additional layers of metallic stent.

Related Topics

    loading  Loading Related Articles