Author + information
- Received September 4, 2002
- Revision received January 21, 2003
- Accepted January 30, 2003
- Published online May 21, 2003.
- Costantino O Costantini, MD*,
- Alexandra J Lansky, MD*,* (, )
- Gary S Mintz, MD, FACC*,
- Kazuyuki Shirai, MD*,
- George Dangas, MD, FACC*,
- Roxana Mehran, MD, FACC*,
- Martin Fahy, PhD*,
- Steven Slack, MS*,
- Maria Coral, MD*,
- Paul S Teirstein, MD, FACC*,
- Ron Waksman, MD, FACC†,
- Gregg Stone, MD, FACC*,
- Jeffrey Moses, MD, FACC* and
- Martin B Leon, MD, FACC*
- ↵*Reprint requests and correspondence:
Dr. Alexandra J. Lansky, Cardiovascular Research Foundation, 55 East 59th Street, 6th Floor, New York, New York 10022, USA.
Objectives We analyzed the effects of vascular brachytherapy (VBT) on ostial in-stent restenosis (ISR).
Background In-stent restenosis has a high recurrence rate after percutaneous reintervention. The recurrence rate of ostial ISR lesions and the impact of VBT remain unknown.
Methods We evaluated 133 patients with native coronary ostial ISR from a pooled database of 990 patients enrolled in randomized VBT trials. Independent quantitative angiography was performed at baseline and follow-up in 45 gamma, 27 beta, and 61 placebo patients.
Results Binary restenosis was significantly higher in placebo than radiated patients (75.4% vs. 17.8% in gamma vs. 22.2% in beta, p < 0.0001). The treatment effect of both gamma (odds ratio [OR] 0.06; 95% confidence interval [CI] 0.02 to 0.17) and beta VBT (OR 0.10; 95% CI 0.03 to 0.31) was maintained after controlling for differences in baseline lesion length. Proximal and distal radiation edge restenosis rates were similar among the groups. Vascular brachytherapy of true aorto-ostial lesions (n = 34) was similarly beneficial: restenosis rates of placebo versus gamma or beta patients of 83.3% versus 6.7% versus 28.6%, p = 0.0002.
Conclusions Conventional treatment of ostial ISR is associated with a recurrence rate of over 75%. Vascular brachytherapy with either gamma or beta sources results in significant and similar reductions in restenosis compared with placebo. Similar benefits after VBT prevail in true aorto-ostial lesions.
- Received September 4, 2002.
- Revision received January 21, 2003.
- Accepted January 30, 2003.
- American College of Cardiology Foundation