Cor Vasa 2003, 44(10):486-490

Effect of a suboptimal outcome of preparatory PTCA on the overall procedural outcome of brachytherapy in the treatment of in-stent restenosis

Jan Kováč^1,*, Marcela Škvařilová², Jan Lukl², Antony H. Gershlick¹

¹ Kardiologická klinika, Glenfieldská nemocnice, Leicester, Velká Británie

² I. interní klinika, Fakultní nemocnice, Olomouc, Česká republika

Aim of study:
To determine the effect of residual post-PTCA stenosis on the outcome of brachytherapy using beta-radiation during six-month clinical and angiographic follow-up.

Methods:
An analysis of the RENO prospective European registry (for radiation-treated patients with in-stent restenoses) using a 90 Sr-Y isotope system in combination with PTCA or an ablation method, focused on the procedural outcome and incidence of adverse events during 6-month follow-up. Data of a total of 1,092 patients entered into the registry were analyzed.

Results:
Six-month follow-up did not reveal a significant difference in the incidence of adverse serious clinical events or the need for subsequent target artery revascularization between groups with minimal (0-10%) and major (10-50%) residual stenosis following preparatory PTCA or atheroablation. Similarly, no significant differences in the incidence of subsequent restenosis were seen in a subgroup of 760 patients undergoing follow-up angiography (25.4% and 25.0%, respectively; NS).

Conclusion:
No significant differences were noted on six-month clinical follow-up in the incidence of MACE, or angiographic incidence of restenosis between groups with minimal residual restenosis and groups with major residual stenoses after PTCA/atheroablation immediately preceding beta-radiation brachytherapy. The outcome of balloon predilatation and/or use of ablation strategies seem to be less important for the mid-term effect of brachytherapy than brachytherapy per se. This effect may be related to the late positive remodeling after brachytherapy as well as to the injury zone limitation in initial PTCA.

Keywords: Brachytherapy; PTCA; Restenosis; Stent

Published: October 1, 2003  Show citation