Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
9935844 | The American Journal of Cardiology | 2005 | 7 Pages |
Abstract
We report the outcomes of patients who had in-stent restenosis (IRS) that was treated with intravascular brachytherapy (IVBT) or sirolimus-eluting stent (SES) implantation. The benefit of IVBT for treating ISR is well documented. SES implantation decreases first-time ISR and, in preliminary reports, has been used to treat ISR. Fifty consecutive patients who had ISR were treated; the first 25 patients underwent SES implantation and the next 25 patients were treated with IVBT using a β-Cath System (a 40-mm strontium-90/yttrium-90 source). Quantitative angiographic and intravascular ultrasound follow-up were performed at 5.2 ± 1.1 and 12.1 ± 1.2 months; clinical follow-up was performed at 15 months. SES deployment and IVBT were successful in all patients. At 12-month follow-up, 8 patients who underwent IVBT had angiographic recurrence (4 in the stent and 4 at the stent edge); only 1 patient who underwent SES implantation developed recurrent ISR. At 12 months, in-stent late luminal loss was similar between the SES and IVBT groups (0.35 ± 0.45 vs 0.34 ± 0.46 mm, p = 0.9); however, in-stent net luminal gain was higher in the SES group than in the IVBT group (1.32 ± 0.13 vs 0.57 ± 0.19 mm, p <0.0001), and in-lesion late luminal loss was higher in the IVBT group (0.48 ± 0.32 vs 0.16 ± 0.42 mm, p = 0.004). At 12 months, intravascular ultrasound stent volume obstruction was higher after IVBT versus than after SES implantation (38.7% vs 6.7%, p <0.0001). At 15-month clinical follow-up, 64% and 96% (p <0.01) of patients who underwent IVBT and SES implantation, respectively, were free of major adverse cardiac events. In conclusion SES implantation for the treatment of ISR was effective and superior to catheter-based IVBT in preventing recurrent neointimal proliferation and angiographic restenosis at 1-year follow-up.
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Authors
Fausto MD, PhD, Juan S. MD, Alexandre MD, PhD, Mariano MD, PhD, Gary S. MD, Rodolfo MD, Marinella MD, PhD, Luiz A. MD, PhD, Galo MD, Luiz F. MD, PhD, Aurea MD, PhD, Ibraim MD, PhD, Andrea S. MD, PhD, Ana C. MD, Vinicius Daher MD, Amanda MD, PhD,