Intracoronary brachytherapy for in-stent restenosis of drug-eluting stents
Purpose: Given the limited salvage options for in-stent restenosis (ISR) of drug-eluting stents (DES), our high-volume cardiac catheterization laboratory has been performing intracoronary brachytherapy (ICBT) in patients with recurrent ISR of DES. This study analyzes their baseline characteristics a...
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doaj-65b3d6e1a29c4676adb2c4ab14bba5d82020-11-24T22:28:08ZengElsevierAdvances in Radiation Oncology2452-10942016-01-01114910.1016/j.adro.2015.12.002Intracoronary brachytherapy for in-stent restenosis of drug-eluting stentsNisha Ohri, MD0Samin Sharma, MD1Annapoorna Kini, MD2Usman Baber, MD3Melissa Aquino, MS4Swathi Roy, MBBS5Ren-Dih Sheu, PhD6Michael Buckstein, MD, PhD7Richard Bakst, MD8Department of Radiation Oncology, Mount Sinai Hospital, New York, New YorkDepartment of Cardiology, Mount Sinai Hospital, New York, New YorkDepartment of Cardiology, Mount Sinai Hospital, New York, New YorkDepartment of Cardiology, Mount Sinai Hospital, New York, New YorkDepartment of Cardiology, Mount Sinai Hospital, New York, New YorkDepartment of Cardiology, Mount Sinai Hospital, New York, New YorkDepartment of Radiation Oncology, Mount Sinai Hospital, New York, New YorkDepartment of Radiation Oncology, Mount Sinai Hospital, New York, New YorkDepartment of Radiation Oncology, Mount Sinai Hospital, New York, New YorkPurpose: Given the limited salvage options for in-stent restenosis (ISR) of drug-eluting stents (DES), our high-volume cardiac catheterization laboratory has been performing intracoronary brachytherapy (ICBT) in patients with recurrent ISR of DES. This study analyzes their baseline characteristics and assesses the safety/toxicity of ICBT in this high-risk population. Methods and materials: A retrospective analysis of patients treated with ICBT between September 2012 and December 2014 was performed. Patients with ISR twice in a single location were eligible. Procedural complications included vessel dissection, perforation, tamponade, slow/absent blood flow, and vessel closure. Postprocedural events included myocardial infarction, coronary artery bypass graft, congestive heart failure, stroke, bleeding, thrombosis, embolism, dissection, dialysis, or death occurring within 72 hours. A control group of patients with 2 episodes of ISR at 1 location who underwent percutaneous coronary intervention without ICBT was identified. Unpaired t tests and χ2 tests were used to compare the groups. Results: There were 134 (78%) patients in the ICBT group with 141 treated lesions and 37 (22%) patients in the control group. There was a high prevalence of hyperlipidemia (>95%), hypertension (>95%), and diabetes (>50%) in both groups. The groups were well-balanced with respect to age, sex, and pre-existing medical conditions, with the exception of previous coronary artery bypass graft being more common the ICBT group. Procedural complication rates were low in the control and ICBT groups (0% vs 4.5%, P = .190). Postprocedural event rates were low (<5%) in both groups. Readmission rate at 30 days was 3.7% in the ICBT group and 5.4% in the control group (P = .649). Conclusions: This is the largest recent known series looking at ICBT for recurrent ISR of DES. ICBT is a safe treatment option with similarly low rates (<5%) of procedural and postprocedural complications compared with percutaneous coronary intervention alone. This study establishes the safety of ICBT in a high-risk patient cohort.http://www.sciencedirect.com/science/article/pii/S2452109415000081 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Nisha Ohri, MD Samin Sharma, MD Annapoorna Kini, MD Usman Baber, MD Melissa Aquino, MS Swathi Roy, MBBS Ren-Dih Sheu, PhD Michael Buckstein, MD, PhD Richard Bakst, MD |
spellingShingle |
Nisha Ohri, MD Samin Sharma, MD Annapoorna Kini, MD Usman Baber, MD Melissa Aquino, MS Swathi Roy, MBBS Ren-Dih Sheu, PhD Michael Buckstein, MD, PhD Richard Bakst, MD Intracoronary brachytherapy for in-stent restenosis of drug-eluting stents Advances in Radiation Oncology |
author_facet |
Nisha Ohri, MD Samin Sharma, MD Annapoorna Kini, MD Usman Baber, MD Melissa Aquino, MS Swathi Roy, MBBS Ren-Dih Sheu, PhD Michael Buckstein, MD, PhD Richard Bakst, MD |
author_sort |
Nisha Ohri, MD |
title |
Intracoronary brachytherapy for in-stent restenosis of drug-eluting stents |
title_short |
Intracoronary brachytherapy for in-stent restenosis of drug-eluting stents |
title_full |
Intracoronary brachytherapy for in-stent restenosis of drug-eluting stents |
title_fullStr |
Intracoronary brachytherapy for in-stent restenosis of drug-eluting stents |
title_full_unstemmed |
Intracoronary brachytherapy for in-stent restenosis of drug-eluting stents |
title_sort |
intracoronary brachytherapy for in-stent restenosis of drug-eluting stents |
publisher |
Elsevier |
series |
Advances in Radiation Oncology |
issn |
2452-1094 |
publishDate |
2016-01-01 |
description |
Purpose: Given the limited salvage options for in-stent restenosis (ISR) of drug-eluting stents (DES), our high-volume cardiac catheterization laboratory has been performing intracoronary brachytherapy (ICBT) in patients with recurrent ISR of DES. This study analyzes their baseline characteristics and assesses the safety/toxicity of ICBT in this high-risk population.
Methods and materials: A retrospective analysis of patients treated with ICBT between September 2012 and December 2014 was performed. Patients with ISR twice in a single location were eligible. Procedural complications included vessel dissection, perforation, tamponade, slow/absent blood flow, and vessel closure. Postprocedural events included myocardial infarction, coronary artery bypass graft, congestive heart failure, stroke, bleeding, thrombosis, embolism, dissection, dialysis, or death occurring within 72 hours. A control group of patients with 2 episodes of ISR at 1 location who underwent percutaneous coronary intervention without ICBT was identified. Unpaired t tests and χ2 tests were used to compare the groups.
Results: There were 134 (78%) patients in the ICBT group with 141 treated lesions and 37 (22%) patients in the control group. There was a high prevalence of hyperlipidemia (>95%), hypertension (>95%), and diabetes (>50%) in both groups. The groups were well-balanced with respect to age, sex, and pre-existing medical conditions, with the exception of previous coronary artery bypass graft being more common the ICBT group. Procedural complication rates were low in the control and ICBT groups (0% vs 4.5%, P = .190). Postprocedural event rates were low (<5%) in both groups. Readmission rate at 30 days was 3.7% in the ICBT group and 5.4% in the control group (P = .649).
Conclusions: This is the largest recent known series looking at ICBT for recurrent ISR of DES. ICBT is a safe treatment option with similarly low rates (<5%) of procedural and postprocedural complications compared with percutaneous coronary intervention alone. This study establishes the safety of ICBT in a high-risk patient cohort. |
url |
http://www.sciencedirect.com/science/article/pii/S2452109415000081 |
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