Author + information
- Creighton W. Don,
- William Lombardi,
- Edward Kim and
- Jing Zeng
Background: Although instent restenosis (ISR) incidence has decreased with new-generation drug-eluting stents, ISR continues to occur in up to 5% of patients after 5-years. ISR rates are much higher in patients who require re-stenting, and those with recurrent ISR following restenting have very high rates of restenosis. Brachytherapy is a viable option to treat recurrent ISR, but 1-year ISR rates remain in the 15-20% range. Drug-eluting balloons (DEB) are a promising new therapy to treat ISR. Combining brachytherapy and DEB may provide synergistic inhibition of the cell growth cycle and further reduce ISR. We present the first reported outcomes of patients who underwent combination treatment with brachytherapy and DEB.
Methods: Retrospective analysis of patients with recurrent ISR of multiple stents was performed at our center. In 2015, we began using a combination of beta-radiation brachytherapy (Best Vascular, Springfield, VA) and Lutonix paclitaxel coated balloons (CR Bard, Murray Hill, NJ) to treat patients. We compared 6-month outcomes to historical controls in the previous year who underwent brachytherapy alone.
Results: Patients undergoing brachytherapy alone (n=31) and combination DEB/brachytherapy (n=10) had similar baseline characteristics. Intravascular ultrasound, laser atherectomy and high pressure balloon inflation were used equally in both groups (70%). Rotational atherectomy was used in one case in each group. Procedural angiographic success, no-reflow (9.6% v. 10%, ns), and reduction in angina class (-2.8 v. -3.0, ns) were similar. There were no MI or deaths at follow-up, but there was one patient with a periprocedural stroke in the brachytherapy group. At follow-up, there were 2 patients (6.4%) in the brachytherapy group and 1 patient in the combination group (10%) who required repeat revascularization.
Conclusions: Combination brachytherapy and DEB is feasible and not associated with increased complications compared to brachytherapy alone. In this small sample, clinical revascularization rates were similar between the two groups. Recurrent ISR is a challenging problem which may benefit from this combination therapy.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Coronary Intervention in Interventional Cardiology: Core Concepts
Abstract Category: 21. Interventional Cardiology: Coronary Intervention: Devices
Presentation Number: 1286-180
- 2017 American College of Cardiology Foundation