TY - JOUR
T1 - Outcomes With Combined Laser Atherectomy and Intravascular Brachytherapy in Recurrent Drug-Eluting Stent In-Stent Restenosis
AU - Megaly, Michael
AU - Glogoza, Matthew
AU - Xenogiannis, Iosif
AU - Vemmou, Evangelia
AU - Nikolakopoulos, Ilias
AU - Omer, Mohamed
AU - Willson, Laura
AU - Monyak, David J.
AU - Sullivan, Patsa
AU - Stanberry, Larissa
AU - Chavez, Ivan
AU - Mooney, Michael
AU - Traverse, Jay
AU - Wang, Yale
AU - Garcia, Santiago
AU - Poulose, Anil
AU - Burke, M. Nicholas
AU - Brilakis, Emmanouil S.
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/1
Y1 - 2021/1
N2 - Background: Recurrent drug-eluting stents (DES) in-stent restenosis (ISR) can be challenging to treat. The combined use of excimer laser atherectomy (ELCA) and vascular brachytherapy (VBT) for this indication has received limited study. Methods: We report the long-term outcomes of patients with recurrent DES ISR treated with combined VBT and ELCA from January 2014 to September 2018 at a single institution. Outcomes included 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. Results: During the study period, 116 patients (143 lesions) underwent VBT, of which 19 patients (19 lesions) underwent combined laser atherectomy and VBT. All procedures were successful without no-reflow or dissection. Two propensity-score matched cohorts (ELCA + VBT (n = 18) vs. VBT only (n = 18)) were compared. During a median follow-up of 25.5 (14.5–40) months, there was no difference in the incidence of TLF (38.9% vs. 38.9%, log-rank p = 0.688), target-lesion MI (5.6% vs. 5.6%, log-rank p = 0.915), or TLR (38.9% vs. 33.3%, log-rank p = 0.933) between both groups. There was no cardiac death related to the target lesion. Conclusions: When compared with VBT alone for the treatment of resistant DES ISR, combined use of ELCA and brachytherapy is associated with comparable long-term outcomes. ELCA should be considered in ISR lesions due to stent underexpansion.
AB - Background: Recurrent drug-eluting stents (DES) in-stent restenosis (ISR) can be challenging to treat. The combined use of excimer laser atherectomy (ELCA) and vascular brachytherapy (VBT) for this indication has received limited study. Methods: We report the long-term outcomes of patients with recurrent DES ISR treated with combined VBT and ELCA from January 2014 to September 2018 at a single institution. Outcomes included 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. Results: During the study period, 116 patients (143 lesions) underwent VBT, of which 19 patients (19 lesions) underwent combined laser atherectomy and VBT. All procedures were successful without no-reflow or dissection. Two propensity-score matched cohorts (ELCA + VBT (n = 18) vs. VBT only (n = 18)) were compared. During a median follow-up of 25.5 (14.5–40) months, there was no difference in the incidence of TLF (38.9% vs. 38.9%, log-rank p = 0.688), target-lesion MI (5.6% vs. 5.6%, log-rank p = 0.915), or TLR (38.9% vs. 33.3%, log-rank p = 0.933) between both groups. There was no cardiac death related to the target lesion. Conclusions: When compared with VBT alone for the treatment of resistant DES ISR, combined use of ELCA and brachytherapy is associated with comparable long-term outcomes. ELCA should be considered in ISR lesions due to stent underexpansion.
KW - ELCA
KW - ISR
KW - IVBT
KW - In-stent restenosis
KW - Intravascular brachytherapy
KW - Laser atherectomy
KW - VBT
KW - Vascular brachytherapy
UR - http://www.scopus.com/inward/record.url?scp=85100446758&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85100446758&partnerID=8YFLogxK
U2 - 10.1016/j.carrev.2020.06.019
DO - 10.1016/j.carrev.2020.06.019
M3 - Letter
C2 - 32571761
AN - SCOPUS:85100446758
SN - 1553-8389
VL - 22
SP - 29
EP - 33
JO - Cardiovascular Revascularization Medicine
JF - Cardiovascular Revascularization Medicine
ER -