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(Circulation. 2002;106:2340.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Long-Term Outcome of Patients Treated With Repeat Percutaneous Coronary Intervention After Failure of -Brachytherapy for the Treatment of In-Stent Restenosis

Ross Prpic, MBBS; Paul S. Teirstein, MD; John P. Reilly, MD; Jeffrey W. Moses, MD; Prabhakar Tripuraneni, MD; Alexandra J. Lansky, MD; Joseph-Anthony Giorgianni, BA; Shirish Jani, PhD; S. Chiu Wong, MD; R. David Fish, MD; Stephen Ellis, MD; David R. Holmes, MD; Dean Kereiakas, MD; Richard E. Kuntz, MD; Martin B. Leon, MD

From the Harvard Clinical Research Institute, Boston, Mass (R.P., R.E.K.); Scripps Clinic, La Jolla, Calif (P.S.T., J.P.R., P.T., S.J.); Cardiovascular Research Foundation, Lenox Hill Hospital, New York, NY (J.W.M., A.J.L., M.B.L.); Cordis, a Johnson and Johnson Company, Warren, NJ (J.-A.G.); Cornell-New York Hospital, New York, NY (S.C.W.); Texas Heart Institute/St. Luke’s Episcopal Hospital and Baylor College of Medicine, Houston, Tex (R.D.F.); Cleveland Clinic, Cleveland, Ohio (S.E.); Mayo Clinic, Rochester, Minn (D.R.H.); and Christ Hospital, Cincinnati, Ohio (D.K.).

Correspondence to Ross Prpic, MBBS, Harvard Clinical Research Institute, 930 Commonwealth Ave, Floor 3, Boston, MA 02215. E-mail rprpic{at}hcri.harvard.edu

Background— Although ¹⁹²Ir intracoronary brachytherapy has been demonstrated to dramatically reduce the recurrence of in-stent restenosis, up to 24% of these patients will still require repeat target-vessel revascularization. The short- and long-term outcomes of repeat percutaneous intervention in this population have not been characterized.

Methods and Results— Analysis was performed of all patients enrolled in the GAMMA-I and GAMMA-II brachytherapy trials who underwent repeat percutaneous target lesion revascularization (TLR) because of restenosis. Subjects were divided into 2 cohorts: those who had received ¹⁹²Ir brachytherapy and those randomized to placebo. Forty-five (17.6%) of a total of 256 patients whose index treatment was intracoronary radiation therapy and 36 (29.8%) of 121 patients whose index treatment was placebo required repeat percutaneous TLR. The mean time to this first TLR was 295±206 days in the irradiated group and 202±167 days in the placebo group (P=0.03). Acute procedural success occurred in 100% of irradiated patients and 94% of placebo controls (P=0.19). After the first TLR, a subsequent TLR was required in 15 (33.3%) of 45 brachytherapy patients versus 17 (47.2%) of 36 placebo failure patients (P=0.26). There was no significant difference in time to second TLR between the 2 groups. Other long-term major adverse event rates in both groups were comparable to those of other contemporary angioplasty/stenting series.

Conclusions— In those patients who "fail" ¹⁹²Ir intracoronary brachytherapy for in-stent restenosis, treatment with ¹⁹²Ir delays the time to first TLR. Additionally, repeat percutaneous intervention in these patients is safe and efficacious in the short term, with acceptable long-term results.

Key Words: angioplasty • stents • restenosis • brachytherapy

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