Background and Objectives Effective treatment for restenosis lesion after intracoronary radiation therapy is not established well. Repeated brachytherapy showed short-term effectiveness in patients with recurred in-stent restenosis. However, its long-term outcome is not known. We performed this study to evaluate the outcomes of repeated brachytherapy (RB) and conventional intervention (CI) for recurred restenosis after intracoronary brachytherapy (ICB).
Materials and Method From Dec. 1998 to Jun. 2002, 111 patients received ICB in our institute. ICB was performed with 188-rhenium filled conventional balloon catheter system to deliver 17.6 Gy at a depth of 1.0 mm into vessel wall from the balloon-artery interface. Twenty-four patients had target lesion revascularization (TLR) during follow up (mean: 10.6 짹 6.7 months). Ten patients were treated with RB and 14 patients with CI. Short- and long-term term angiographic and clinical outcome of these 2 groups were analyzed and compared.
Results There were no significant differences in baseline clinical and angiographic characteristics in two groups. Treatment modalities in CI group were 7 additional stenting, 3 balloon angioplasty, 2 cutting balloon angioplasties, 1 directional atherectomy and 1 rotational atherectomy. RB was performed with the same method as the initial brachytherapy. Mean follow-up duration was 33 짹 16 months and 27 짹 14 months in RB and CI group respectively. At 9 months after treatment, TLR was occurred in no patient in RB group and 3 (21%) in CI group (p=0.08). During the long term follow up, there were additional 3 TLRs (at 15th, 25th, 44th month) in RB group and 1 additional TLR (at 34th month) in CI group. Therefore, cumulative TLR rate was 30% of RB group and 29% of CI group. There were no clinical and angiographic events related to repeated brachytherapy.
Conclusion In patients with recurred restenosis after ICB, RB seems to be feasible and safe. RB reduced the short term TLR rate. However, late catch up during long term follow up lessened the effectiveness of RB.