Establishing The Safety Of Intracoronary Brachytherapy For In-Stent Restenosis Of Drug-Eluting Stents

In-stent restenosis (ISR) after percutaneous coronary intervention (PCI) remains an important clinical issue, even in the era of drug-eluting stents (DES). Our high-volume cardiac catheterization laboratory has a renewed interest in ICBT for patients with recurrent ISR of DES. This study aimed to assess the safety and toxicity of ICBT for ISR of DES by examining procedural and post procedural complication rates. We established a prospective cohort of patients treated with ICBT at our institution between September 2012 and September 2014. Patients who developed ISR twice in a single location were eligible for ICBT. We retrospectively established a control group of patients who also had two episodes of ISR at one location and underwent PCI without ICBT treated over the same time period. Procedural complications included grade 3 vessel dissection, perforation, slow or absent blood flow, side branch closure, and vessel closure. Post procedural events included myocardial infarction (MI), coronary artery bypass graft (CABG), congestive heart failure (CHF), stroke, bleeding, thrombosis, embolism, dissection, dialysis, or death occurring within 72 hours after PCI. Unpaired t-tests and chi-square tests were used to compare the ICBT and control groups. There were 134 (78%) patients in the ICBT group and 37 (22%) in the control group. Baseline characteristics are listed in Table 1. The groups were well-balanced with respect to age, sex, and pre-existing medical conditions, with the exception of previous CABG being more common the ICBT group. Procedural complication rates were low for both groups (0% control group vs 4.5% ICBT group, P=.190). Post procedural event rates were also low. Five patients (3.7%) in the ICBT group experienced an MI compared to none in the control group (P=.233). One patient (2.7%) in the control group required dialysis compared to none in the ICBT group (P=.056). No additional events including CABG, CHF, stroke, bleeding, thrombosis, embolism, dissection, or death were recorded. Readmission rate for any cause at 30 days was low in both the ICBT (3.7%) and control (5.4%) groups (P=.649). This is the largest recent known series looking at ICBT in the setting of ISR in DES; ICBT is a safe treatment option with similarly low rates (<5%) of procedural and post procedural complications compared to PCI alone, even in a high-risk cardiac patient population.Poster Viewing Abstracts 3160; Table 1Control n=37 (%)ICBT n=134 (%)P-valueAge, median (years)6165.5.080Male gender25 (67.6)100 (74.6).391Pre-existing medical conditionsHyperlipidemia36 (97.3)134 (100.0).056Hypertension37 (100.0)133 (99.3).598Diabetes mellitus24 (64.9)79 (59.0).516Previous MI10 (27.0)59 (44.0).062Previous CABG9 (24.3)62 (46.3).017Stroke6 (16.2)20 (14.9).847 Open table in a new tab