Correlates of failure following treatment with Sr-90 beta irradiation for in-stent restenosis

• Published in: Catheterization and cardiovascular interventions 2003-06, Vol.59 (2), p.176-183
• Main Authors: Almeda, Francis Q., Chua, David Y., Nathan, Sandeep, Kim, Susie, Meyer, Peter M., Nguyen, Cam, Chu, James C.H., Kavinsky, Clifford J., Snell, R. Jeffrey, Schaer, Gary L.
• Format: Article
• Language: English
• Subjects: Aged; Beta Particles - therapeutic use; Biological and medical sciences; Blood Vessel Prosthesis Implantation; Brachytherapy; Coronary Angiography; Coronary Artery Disease - complications; Coronary Artery Disease - epidemiology; Coronary Artery Disease - surgery; Coronary Restenosis - epidemiology; Coronary Restenosis - etiology; Coronary Restenosis - radiotherapy; coronary vessels; Diseases of the cardiovascular system; Endpoint Determination; Female; Follow-Up Studies; Humans; Illinois - epidemiology; Incidence; intracoronary radiation therapy; Male; Medical sciences; Middle Aged; Multivariate Analysis; ostial lesion; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Randomized Controlled Trials as Topic; restenosis; Retrospective Studies; Severity of Illness Index; Statistics as Topic; stent; Stents; Strontium Radioisotopes - therapeutic use; Treatment Failure; vascular brachytherapy
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.10496

We sought to determine the correlates of failure following intracoronary radiation therapy (IRT) with Sr‐90 using the Novoste Beta‐Cath system for the treatment of in‐stent restenosis (ISR) in a broad range of patients. IRT has been shown to be more efficacious compared to placebo for the treatment of ISR in large randomized trials. However, even in patients treated with IRT, major adverse cardiac events occur in approximately 20% of cases on follow‐up. This trial sought to elucidate the correlates of failure following successful IRT for ISR. To determine the correlates of IRT failure, we retrospectively compared the demographics, lesion characteristics, and clinical outcomes of 102 consecutive patients with ISR treated with Sr‐90 from September 1998 to July 2001. IRT failure was defined as death, myocardial infarction (MI), or target vessel revascularization (TVR) due to repeat ISR on follow‐up. A comparison of the clinical and angiographic profile of IRT failures (n = 16) vs. IRT successes (n = 86) revealed that a history of smoking (75% vs. 40%; P = 0.012), current use of calcium channel blockers (84% vs. 45%; P = 0.013), ostial location of target lesion (44% vs. 16%; P = 0.020), and mean posttreatment minimal luminal diameter (MLD; 1.64 ± 0.19 vs. 2.21 ± 0.29 mm; P < 0.001), respectively, were correlated with failure using univariate analysis. After multivariate regression analysis, the correlates of failure that remained significant were treatment of an ostial lesion (OR = 31.2; 95% CI = 2.6–382.7; P = 0.007) and final posttreatment MLD (P < 0.001). Ostial location of target lesion and smaller posttreatment MLD are correlated with subsequent death, MI, and TVR following therapy with Sr‐90 for ISR. Cathet Cardiovasc Intervent 2003;59:176–183. © 2003 Wiley‐Liss, Inc.