Comparison between drug-eluting stents and beta-radiation for the treatment of diffuse in-stent restenosis: Clinical and angiographic outcomes

• Published in: The American heart journal Vol. 152; no. 5; pp. 908.e1 - 908.e7
• Main Authors: Zavalloni, Dennis, Belli, Guido, Rossi, Marco L., Scatturin, Melania, Morenghi, Emanuela, Catalano, Gianpiero, Tosi, Giovanni, Gasparini, Gabriele L., Pagnotta, Paolo, Presbitero, Patrizia
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-11-2006; Elsevier Limited
• Subjects: Aged; Angioplasty; Beta Particles - therapeutic use; Blood Vessel Prosthesis Implantation - adverse effects; Brachytherapy; Cardiology; Catheters; Coronary Angiography; Coronary Restenosis - diagnostic imaging; Coronary Restenosis - drug therapy; Coronary Restenosis - etiology; Coronary Restenosis - radiotherapy; Drug Delivery Systems; Drug dosages; Female; Humans; Immunosuppressive Agents - administration & dosage; Male; Medical imaging; Middle Aged; Multivariate analysis; Paclitaxel - administration & dosage; Patients; Radiation therapy; Sirolimus - administration & dosage; Stents
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2006.01.014

Initial reports on drug-eluting stents (DES) for the treatment for in-stent restenosis (ISR) show very good outcomes. Nevertheless, few data are available on direct comparison with intracoronary brachytherapy (IBT). The aim of this study was to compare brachytherapy and DES in treatment of diffuse ISR.
One hundred forty-one consecutive patients with diffuse ISR were treated with IBT (68 patients; beta (
90Sr/
90Y) emitters) or with DES (73 patients; 32 with sirolimus-eluting and 41 with paclitaxel-eluting stents). Angiographic and clinical follow-up was scheduled within 9 months.
The first 74 lesions were treated with IBT (group 1) and the latter 74 with DES (group 2). The two groups were well matched for clinical/angiographic characteristics. At follow-up, restenosis rates were 37.8% (28/74) in IBT group and 14.9% (11/74) in DES group (
P = .0028). A diffuse pattern of recurrence was more frequent after IBT (20/74 vs 6/74,
P = .005). A worse outcome after IBT was associated with the “edge effect,” accounting for most failures. Recurrence within the original restenotic stent was similar in both groups (12.9% vs 14.9% in groups 1 and 2 respectively,
P = .8).
Drug-eluting stents are more effective than IBT with beta-irradiation in reducing recurrence rates after treatment of diffuse ISR. In case of failure, the pattern of restenosis is more benign after treatment with DES.