Chronic total occlusion due to diffuse in-stent restenosis: Is brachytherapy the solution?

E. Nikolsky, Luis Gruberg, E. Rosenblatt, E. Grenadier, M. Boulos, Z. Bernstein, A. Huber, R. Gitman, R. Bar-Deroma, W. Markiewicz, R. Beyar

Research output: Contribution to journalArticle

Abstract

Percutaneous coronary intervention of chronic total occlusions (CTO) is associated with a significantly higher incidence of reocclusion and restenosis compared with non-total occlusions. Randomized and observational trials have demonstrated the effectiveness of intracoronary brachytherapy (ICBT) for the prevention of recurrent in-stent restenosis. However, limited data are available on the effectiveness of ICBT in patients with totally occluded in-stent restenosis. The authors assessed the long-term outcome of patients treated with intracoronary gamma radiation for totally occluded in-stent restenotic lesions. Percutaneous coronary intervention and subsequent catheter-based irradiation with iridium-192 was performed in 100 patients (103 vessels) with diffuse in-stent restenosis. At baseline, CTO of the target vessel at the site of the stent was present in 15 vessels (14.5%). Follow-up data were collected during follow-up visits and from telephone interviews. Repeat coronary angiography was performed in symptomatic patients with clinical restenosis. Clinical and angiographic characteristics were similar between the two groups, although there was a trend towards more unstable angina at the index procedure in CTO patients (66.7% versus 41.4%; p = 0.12) compared with patients without non-total occlusions. A higher percentage of patients (53.3%) with CTO required longer radiation sources (14 seeds, covering a length of 55 mm), compared with 23.9% of patients with non-total occlusion (p = 0.04). With a mean follow-up period of 47.5 ± 24.0 months, major adverse cardiac events (MACE) were observed in 10 of 15 patients (66.7%) with CTO compared with 25 out of 88 patients (28.4%) without CTO (p= 0.009). According to multivariate analysis, total occlusion of the target vessel at baseline was the single independent predictor of MACE at one-year follow-up (relative risk 16.2, 95% confidence interval 4.2-62.9; p <0.0001). This study shows that the use of gamma radiation for the prevention of recurrence of in-stent restenosis in patients with CTO does not seem to be as effective as in patients with non-total occlusions. Furthermore, CTO was an independent predictor of worse outcome at long-term follow-up in this study.

Original languageEnglish (US)
Pages (from-to)33-38
Number of pages6
JournalInternational Journal of Cardiovascular Interventions
Volume6
Issue number1
DOIs
StatePublished - 2004
Externally publishedYes

Fingerprint

Brachytherapy
Stents
Gamma Rays
Percutaneous Coronary Intervention
Iridium
Unstable Angina
Coronary Angiography
Seeds
Multivariate Analysis
Catheters
Confidence Intervals
Interviews
Radiation

Keywords

  • Brachytherapy
  • Radiation
  • Restenosis
  • Stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Nikolsky, E., Gruberg, L., Rosenblatt, E., Grenadier, E., Boulos, M., Bernstein, Z., ... Beyar, R. (2004). Chronic total occlusion due to diffuse in-stent restenosis: Is brachytherapy the solution? International Journal of Cardiovascular Interventions, 6(1), 33-38. https://doi.org/10.1080/14628840310004892

Chronic total occlusion due to diffuse in-stent restenosis : Is brachytherapy the solution? / Nikolsky, E.; Gruberg, Luis; Rosenblatt, E.; Grenadier, E.; Boulos, M.; Bernstein, Z.; Huber, A.; Gitman, R.; Bar-Deroma, R.; Markiewicz, W.; Beyar, R.

In: International Journal of Cardiovascular Interventions, Vol. 6, No. 1, 2004, p. 33-38.

Research output: Contribution to journalArticle

Nikolsky, E, Gruberg, L, Rosenblatt, E, Grenadier, E, Boulos, M, Bernstein, Z, Huber, A, Gitman, R, Bar-Deroma, R, Markiewicz, W & Beyar, R 2004, 'Chronic total occlusion due to diffuse in-stent restenosis: Is brachytherapy the solution?', International Journal of Cardiovascular Interventions, vol. 6, no. 1, pp. 33-38. https://doi.org/10.1080/14628840310004892
Nikolsky, E. ; Gruberg, Luis ; Rosenblatt, E. ; Grenadier, E. ; Boulos, M. ; Bernstein, Z. ; Huber, A. ; Gitman, R. ; Bar-Deroma, R. ; Markiewicz, W. ; Beyar, R. / Chronic total occlusion due to diffuse in-stent restenosis : Is brachytherapy the solution?. In: International Journal of Cardiovascular Interventions. 2004 ; Vol. 6, No. 1. pp. 33-38.
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AU - Grenadier, E.

AU - Boulos, M.

AU - Bernstein, Z.

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