TY - JOUR
T1 - Outcomes of intravascular brachytherapy for recurrent drug-eluting in-stent restenosis
AU - Megaly, Michael
AU - Glogoza, Matthew
AU - Xenogiannis, Iosif
AU - Vemmou, Evangelia
AU - Nikolakopoulos, Ilias
AU - Willson, Laura
AU - Monyak, David J.
AU - Sullivan, Patsa
AU - Stanberry, Larissa
AU - Sorajja, Paul
AU - Chavez, Ivan
AU - Mooney, Michael
AU - Traverse, Jay
AU - Wang, Yale
AU - Garcia, Santiago
AU - Poulose, Anil
AU - Burke, Martin Nicholas
AU - Brilakis, Emmanouil S.
N1 - Funding Information:
M. Megaly., M.G., I.X., E.V., I.N., L.W., D.J.M., L.S., I.C., M. Mooney, J.T., Y.W., A.P., and P. Sullivan: Nothing to disclose. P. Sorajja: Consulting, speaking for Abbott Vascular, Edwards Lifesciences, Medtronic, and Boston Scientific; equity and consulting for Pipeline Technologies and Admedus. S.G.: Consultant for Surmodics, Osprey Medical, Medtronic, Edwards Lifesciences, and Abbott. Grant support from Edwards Lifesciences and the VA Office of Research and Development. M.N.B.: Consulting and speaker honoraria from Opsens Medical. Shareholder, Egg Medical and MHI Ventures. E.S.B.: Consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, InfraRedx, Medtronic, Siemens, and Teleflex; research support from Regeneron and Siemens. Shareholder: MHI Ventures.
Funding Information:
Minneapolis Heart Institute Foundation
Publisher Copyright:
© 2020 Wiley Periodicals, Inc.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Objectives: To examine the outcomes of vascular brachytherapy (VBT) for recurrent drug-eluting stents (DES) in-stent restenosis (ISR). Background: Recurrent DES-ISR can be challenging to treat. VBT has been used with encouraging results. Methods: We report the long-term outcomes of patients with recurrent DES-ISR treated with VBT between January 2014 and September 2018 at a tertiary care institution. The main outcome was target lesion failure (TLF), defined as the composite of clinically driven target lesion revascularization (TLR), target lesion myocardial infarction (MI), and target lesion-related cardiac death. Cox proportional hazards analysis was performed to identify variables associated with recurrent TLF. Results: During the study period, 116 patients (143 lesions) underwent VBT. Median follow-up was 24.7 (14.5–35.4) months. The incidence of TLR, target-lesion MI, and TLF was 18.9%, 5.6%,and 20.1% at 1 year, and 29.4%, 10.5%, and 32.9% at 2 years.Initial presentation with acute coronary syndrome (ACS) was independently associated with TLF (hazard ratio = 1.975, 95% CI [1.120, 3.485], p =.019). Lesions treated with intravascular ultrasound (IVUS) guidance had a lower incidence of TLR (14.3% vs. 39.6%, log-rank p =.038), and a trend toward lower incidence of TLF (19% vs. 42.6%, log-rank p =.086). Conclusions: VBT can improve the treatment of recurrent DES-ISR, but TLF occurs in approximately one in three patients at 2 years. Initial presentation with ACS was associated with higher TLF and the use of IVUS with a trend for lower incidence of TLF.
AB - Objectives: To examine the outcomes of vascular brachytherapy (VBT) for recurrent drug-eluting stents (DES) in-stent restenosis (ISR). Background: Recurrent DES-ISR can be challenging to treat. VBT has been used with encouraging results. Methods: We report the long-term outcomes of patients with recurrent DES-ISR treated with VBT between January 2014 and September 2018 at a tertiary care institution. The main outcome was target lesion failure (TLF), defined as the composite of clinically driven target lesion revascularization (TLR), target lesion myocardial infarction (MI), and target lesion-related cardiac death. Cox proportional hazards analysis was performed to identify variables associated with recurrent TLF. Results: During the study period, 116 patients (143 lesions) underwent VBT. Median follow-up was 24.7 (14.5–35.4) months. The incidence of TLR, target-lesion MI, and TLF was 18.9%, 5.6%,and 20.1% at 1 year, and 29.4%, 10.5%, and 32.9% at 2 years.Initial presentation with acute coronary syndrome (ACS) was independently associated with TLF (hazard ratio = 1.975, 95% CI [1.120, 3.485], p =.019). Lesions treated with intravascular ultrasound (IVUS) guidance had a lower incidence of TLR (14.3% vs. 39.6%, log-rank p =.038), and a trend toward lower incidence of TLF (19% vs. 42.6%, log-rank p =.086). Conclusions: VBT can improve the treatment of recurrent DES-ISR, but TLF occurs in approximately one in three patients at 2 years. Initial presentation with ACS was associated with higher TLF and the use of IVUS with a trend for lower incidence of TLF.
KW - in-stent restenosis
KW - intravascular brachytherapy
KW - vascular brachytherapy
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U2 - 10.1002/ccd.28716
DO - 10.1002/ccd.28716
M3 - Article
C2 - 31943747
AN - SCOPUS:85078302728
SN - 1522-1946
VL - 97
SP - 32
EP - 38
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 1
ER -