Percutaneous coronary intervention followed by intravascular brachytherapy for management 
of drug-eluting stents in-stent restenosis in patients 
with complex coronary artery lesions

Mark Trombetta; Hirsch Matani; Hardik A. Valand; Siddharth B. Reddy; Triston B. Smith; Daniel Pavord; David Lasorda

doi:10.5114/jcb.2025.158502

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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abstract:

Original paper

Percutaneous coronary intervention followed by intravascular brachytherapy for management of drug-eluting stents in-stent restenosis in patients with complex coronary artery lesions

Mark Trombetta

^{1, 2}

,

Hirsch Matani

¹

,

Hardik A. Valand

³

,

Siddharth B. Reddy

⁴

,

Triston B. Smith

⁵

,

Daniel Pavord

¹

,

David Lasorda

^{2, 3}

Division of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA 15212, USA
Drexel University College of Medicine, Pittsburgh Campus, Pittsburgh, PA 15212, USA
Division of Interventional Cardiology, Allegheny General Hospital, Pittsburgh, PA 15212, USA
Baptist Memorial Hospital, Columbus, MS 39705, USA
Division of Cardiology, Trinity Health System, Steubenville, OH 43952, USA

DOI: https://doi.org/10.5114/jcb.2025.158502

Online publish date: 2025/12/31

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AMA

Trombetta M, Matani H, Valand H, et al. Percutaneous coronary intervention followed by intravascular brachytherapy for management 
of drug-eluting stents in-stent restenosis in patients 
with complex coronary artery lesions. Journal of Contemporary Brachytherapy. 2025. doi:10.5114/jcb.2025.158502.

APA

Trombetta, M., Matani, H., Valand, H., Reddy, S., Smith, T.,  & Pavord, D. et al. (2025). Percutaneous coronary intervention followed by intravascular brachytherapy for management 
of drug-eluting stents in-stent restenosis in patients 
with complex coronary artery lesions. Journal of Contemporary Brachytherapy. https://doi.org/10.5114/jcb.2025.158502

Chicago

Trombetta, Mark, Hirsch Matani, Hardik A. Valand, Siddharth B. Reddy, Triston B. Smith, Daniel Pavord,  and David Lasorda. 2025. "Percutaneous coronary intervention followed by intravascular brachytherapy for management 
of drug-eluting stents in-stent restenosis in patients 
with complex coronary artery lesions". Journal of Contemporary Brachytherapy. doi:10.5114/jcb.2025.158502.

Harvard

Trombetta, M., Matani, H., Valand, H., Reddy, S., Smith, T., Pavord, D.,  and Lasorda, D. (2025). Percutaneous coronary intervention followed by intravascular brachytherapy for management 
of drug-eluting stents in-stent restenosis in patients 
with complex coronary artery lesions. Journal of Contemporary Brachytherapy. https://doi.org/10.5114/jcb.2025.158502

MLA

Trombetta, Mark et al. "Percutaneous coronary intervention followed by intravascular brachytherapy for management 
of drug-eluting stents in-stent restenosis in patients 
with complex coronary artery lesions." Journal of Contemporary Brachytherapy, 2025. doi:10.5114/jcb.2025.158502.

Vancouver

Trombetta M, Matani H, Valand H, Reddy S, Smith T, Pavord D et al. Percutaneous coronary intervention followed by intravascular brachytherapy for management 
of drug-eluting stents in-stent restenosis in patients 
with complex coronary artery lesions. Journal of Contemporary Brachytherapy. 2025. doi:10.5114/jcb.2025.158502.

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.

keywords:

Percutaneous coronary intervention followed by intravascular brachytherapy for management of drug-eluting stents in-stent restenosis in patients with complex coronary artery lesions

Mark Trombetta 1, 2 , Hirsch Matani 1 , Hardik A. Valand 3 , Siddharth B. Reddy 4 , Triston B. Smith 5 , Daniel Pavord 1 , David Lasorda 2, 3

coronary artery disease, intravascular brachytherapy, restenosis, radiation

Mark Trombetta

^{1, 2}

,

Hirsch Matani

¹

,

Hardik A. Valand

³

,

Siddharth B. Reddy

⁴

,

Triston B. Smith

⁵

,

Daniel Pavord

¹

,

David Lasorda

^{2, 3}