Purpose

Coronary artery disease is the leading cause of death for both men and women in the United States. Percutaneous coronary intervention with drug-eluting stents (DES) has been a major advance in treatment. In-stent restenosis (ISR) occurs in up to 10% of patients, and is often managed with repeat DES placement. However, when DES-ISR occurs, treatment options remain limited. Angioplasty followed by intravascular brachytherapy (IVBT) is one option for such patients.

Material and methods

Outcomes of 78 patients (91 vessels) treated with angioplasty followed by strontium-90 IVBT from 2016-2024 were reviewed. Following vessel preparation with angioplasty, an intravascular catheter was introduced into the index lesion. Radiation was prescribed to an area encompassing the angioplasty injury length with a minimum 10 mm margin. Radiation dose delivered was 23 Gy or 18.4 Gy according to protocol standard. Major adverse cardiac events (MACE), including myocardial infarction and stroke as well as all causes of death were analyzed, as was the need for repeat angioplasty or intervention.

Results

All patients had at least 2 drug-eluting stents previously deployed in the affected vessel, and were not technically suitable for additional stenting. One patient expired while receiving intervention due to cardiac arrest, with no other intraprocedural toxicities reported. Median follow-up was 22.8 months (range, 0.9-60.6 months), and forty-four percent of patients experienced symptomatic relief. Major cardiac adverse events rates at interval follow-up of IVBT included myocardial infarction (18%) and stroke (5%). Death from any cause occurred in 16% of patients at a median time of 9.3 months post-treatment (range, 0.5-29.5 months).

Conclusions

Angioplasty followed by intravascular brachytherapy is a safe and effective therapy for patients with complex coronary artery lesions experiencing stent-in-stent restenosis, who have few other treatment options.