Intracoronary brachytherapy following drug-eluting stent failure It's still not time to hang up the spikes

Drug-eluting stents (DES) have significantly reduced the incidence of restenosis. Although the results obtained with these novel antiproliferative devices are encouraging, recent reports have shown that DES are not completely immune from restenosis. Therefore, the broad use of DES has inevitably led...

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Published in:Cardiovascular radiation medicine 2003-10, Vol.4 (4), p.171-175
Main Authors: Angiolillo, Dominick J, Sabaté, Manel, Jiménez-Quevedo, Pilar, Alfonso, Fernando, Galván, Carmen, Fernández, José Miguel, Hernandez-Antolin, Rosana, Escaned, Javier, Bañuelos, Camino, Moreno, Raul, Macaya, Carlos
Format: Article
Language:English
Subjects:
Adult
Aged
BRACHYTHERAPY
Coronary Restenosis - radiotherapy
Coronary Restenosis - surgery
Drug-eluting stents
DRUGS
FAILURES
Female
Follow-Up Studies
Graft Occlusion, Vascular - radiotherapy
Humans
Immunosuppressive Agents - administration & dosage
Intracoronary brachytherapy
Male
Middle Aged
Paclitaxel - administration & dosage
PATIENTS
RADIOLOGY AND NUCLEAR MEDICINE
Restenosis
Retreatment
SAFETY STANDARDS
Sirolimus - administration & dosage
Stents
Treatment Failure
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Summary:Drug-eluting stents (DES) have significantly reduced the incidence of restenosis. Although the results obtained with these novel antiproliferative devices are encouraging, recent reports have shown that DES are not completely immune from restenosis. Therefore, the broad use of DES has inevitably led to a major issue: treatment of DES failure. Intracoronary brachytherapy (IBT) represents an important advancement for treatment of in-stent restenosis (ISR) and has led to important pathophysiological insight on the restenotic process. To date, IBT, when properly used, still represents the gold standard for treatment of ISR. However, experience with IBT is for treatment of ISR occurring with bare metal stents (BMS). Whether IBT may be used with the same safety and efficacy profile as an adjunctive treatment for ISR following DES implantation is still unknown. In this article, we report the outcome of a series of patients with DES failure treated with IBT. IBT for treatment of DES failure was shown to be both safe and efficient and, therefore, until ISR exists, IBT still remains an important player in this growing and even more challenging setting.
ISSN:1522-1865
DOI:10.1016/j.carrad.2004.02.003