Coronary intravascular brachytherapy for recurrent coronary drug-eluting in-stent restenosis: A systematic review and meta-analysis

Michael Megaly, Matthew Glogoza, Iosif Xenogiannis, Evangelia Vemmou, Ilias Nikolakopoulos, Mohamed Omer, Marwan Saad, Laura Willson, David J. Monyak, Patsa Sullivan, Ashish Pershad, Ivan Chavez, Michael Mooney, Jay Traverse, Yale Wang, Santiago Garcia, Anil Poulose, M. Nicholas Burke, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To examine the outcomes with intravascular brachytherapy (IVBT) in recurrent in-stent restenosis (ISR). Background: Recurrent ISR can be challenging to treat and IVBT can be used for recurrent ISR but has received limited study. Methods: We performed a systematic review and meta-analysis of five observational studies, including 917 patients (1014 lesions) with recurrent ISR, defined as having at least two prior ISR episodes with previous treatment with a stent, who underwent treatment with IVBT. Outcomes of interest included target vessel revascularization (TVR), myocardial infarction (MI), and all-cause mortality. Results: During a mean follow-up of 24 ± 7 months, the incidence of TVR was 29.2% (95% CI 18.0–40.4%). The incidence of MI and all-cause mortality were 4.3% (95% CI 1.7%–6.9%) and 7.3% (95% CI 3.2–11.5%), respectively. At one- and two-years after PCI the incidence of TVR was 17.5% (95% CI 13.6%–21.4%) and 26.7% (95% CI 16.6%–36.9%), respectively and the incidence of MI was 3.1% (95% CI 2–4.2%) and 3.9% (95% CI 1–6.8%), respectively. Conclusion: Intravascular brachytherapy can be used to treat recurrent ISR, although TVR is needed in approximately one of four patients at two years.

Original languageEnglish (US)
JournalCardiovascular Revascularization Medicine
DOIs
StateAccepted/In press - 2020

Keywords

  • DES ISR
  • In-stent restenosis
  • Intravascular brachytherapy
  • IVBT

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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