Long-term outcome of patients treated with repeat percutaneous coronary intervention after failure of gamma-brachytherapy for the treatment of in-stent restenosis

• Published in: Circulation (New York, N.Y.) N.Y.), 2002-10, Vol.106 (18), p.2340-2345
• Main Authors: Prpic, Ross, Teirstein, Paul S, Reilly, John P, Moses, Jeffrey W, Tripuraneni, Prabhakar, Lansky, Alexandra J, Giorgianni, Joseph-Anthony, Jani, Shirish, Wong, S Chiu, Fish, R David, Ellis, Stephen, Holmes, David R, Kereiakas, Dean, Kuntz, Richard E, Leon, Martin B
• Format: Article
• Language: English
• Subjects: Angioplasty, Balloon, Coronary - adverse effects; Brachytherapy - adverse effects; Cohort Studies; Coronary Restenosis - radiotherapy; Coronary Restenosis - surgery; Disease-Free Survival; Female; Follow-Up Studies; Humans; Iridium Radioisotopes - adverse effects; Iridium Radioisotopes - therapeutic use; Male; Middle Aged; Randomized Controlled Trials as Topic - statistics & numerical data; Recurrence; Reoperation; Stents - adverse effects; Time; Treatment Outcome
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.0000036366.62288.74

Although (192)Ir intracoronary brachytherapy has been demonstrated to dramatically reduce the recurrence of in-stent restenosis, up to 24% of these patients will still require repeat target-vessel revascularization. The short- and long-term outcomes of repeat percutaneous intervention in this population have not been characterized. Analysis was performed of all patients enrolled in the GAMMA-I and GAMMA-II brachytherapy trials who underwent repeat percutaneous target lesion revascularization (TLR) because of restenosis. Subjects were divided into 2 cohorts: those who had received (192)Ir brachytherapy and those randomized to placebo. Forty-five (17.6%) of a total of 256 patients whose index treatment was intracoronary radiation therapy and 36 (29.8%) of 121 patients whose index treatment was placebo required repeat percutaneous TLR. The mean time to this first TLR was 295+/-206 days in the irradiated group and 202+/-167 days in the placebo group (P=0.03). Acute procedural success occurred in 100% of irradiated patients and 94% of placebo controls (P=0.19). After the first TLR, a subsequent TLR was required in 15 (33.3%) of 45 brachytherapy patients versus 17 (47.2%) of 36 placebo failure patients (P=0.26). There was no significant difference in time to second TLR between the 2 groups. Other long-term major adverse event rates in both groups were comparable to those of other contemporary angioplasty/stenting series. In those patients who "fail" (192)Ir intracoronary brachytherapy for in-stent restenosis, treatment with (192)Ir delays the time to first TLR. Additionally, repeat percutaneous intervention in these patients is safe and efficacious in the short term, with acceptable long-term results.