Intracoronary β-radiation for the treatment of patients at very high risk for recurrence of in-stent restenosis: A single center experience

Dennis Zavalloni Parenti, Federica Marsico, Giovanni Tosi, Gianpiero Catalano, Luigi Maiello, Francesco Milone, Addolorata Carcagnì, Paolo Giay Pron, Roberto Orecchia, Patrizia Presbitero

Research output: Contribution to journalArticle

Abstract

Background. Intracoronary brachytherapy has significantly reduced the recurrence of in-stent restenosis. The aim of this study was to evaluate the feasibility, safety and efficacy of intracoronary β-radiation in patients at very high risk for recurrence of in-stent restenosis. Methods. We analyzed 42 patients with 50 lesions submitted to catheter-based β-radiation (Beta-Cath System, Novoste Corporation, Norcross, GA, USA) for in-stent restenosis. Thirty-eight lesions were at the second restenosis, 8 at the third, and 4 at the fourth; a diffuse pattern was present in 78%. Results. Balloon angioplasty was performed for 30 lesions (60%) and the cutting balloon technique for 20 (40%). In 12 lesions further 14 stents had to be deployed (28%). The delivery catheter was successfully positioned in 96% of the procedures. The mean dwell time was 179 ± 50 s with a radiation dose ranging from 18.4 to 25.3 Gy, depending on the vessel size. A complete angiographic success without coronary dissection and without any additional stenting after radiation delivery was achieved in 86%. At follow-up (7.2 ± 2.1 months), the overall restenosis rate was 30.4% (14 lesions). A recurrence was detected in 1/11 lesions with initial focal pattern and in 13/39 lesions with initial diffuse pattern. The restenosis rate was higher in patients in whom a geographic miss had occurred (p <0.05 vs lesions without geographic miss) and in those in whom a new stent had been deployed (p <0.05 vs lesions treated without a stent). Conclusions. Brachytherapy reduces the in-stent restenosis rate in patients who are at very high risk of recurrence. The restenosis pattern, geographic miss and new stent deployment seem to be negative prognostic factors for recurrence of restenosis.

Original languageEnglish
Pages (from-to)199-204
Number of pages6
JournalItalian Heart Journal
Volume4
Issue number3
Publication statusPublished - Mar 1 2003

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Stents
Radiation
Recurrence
Brachytherapy
Therapeutics
Catheters
Beta Particles
Balloon Angioplasty
Dissection
Safety

Keywords

  • Coronary stent
  • Restenosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Intracoronary β-radiation for the treatment of patients at very high risk for recurrence of in-stent restenosis : A single center experience. / Zavalloni Parenti, Dennis; Marsico, Federica; Tosi, Giovanni; Catalano, Gianpiero; Maiello, Luigi; Milone, Francesco; Carcagnì, Addolorata; Pron, Paolo Giay; Orecchia, Roberto; Presbitero, Patrizia.

In: Italian Heart Journal, Vol. 4, No. 3, 01.03.2003, p. 199-204.

Research output: Contribution to journalArticle

Zavalloni Parenti, D, Marsico, F, Tosi, G, Catalano, G, Maiello, L, Milone, F, Carcagnì, A, Pron, PG, Orecchia, R & Presbitero, P 2003, 'Intracoronary β-radiation for the treatment of patients at very high risk for recurrence of in-stent restenosis: A single center experience', Italian Heart Journal, vol. 4, no. 3, pp. 199-204.
Zavalloni Parenti, Dennis ; Marsico, Federica ; Tosi, Giovanni ; Catalano, Gianpiero ; Maiello, Luigi ; Milone, Francesco ; Carcagnì, Addolorata ; Pron, Paolo Giay ; Orecchia, Roberto ; Presbitero, Patrizia. / Intracoronary β-radiation for the treatment of patients at very high risk for recurrence of in-stent restenosis : A single center experience. In: Italian Heart Journal. 2003 ; Vol. 4, No. 3. pp. 199-204.
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abstract = "Background. Intracoronary brachytherapy has significantly reduced the recurrence of in-stent restenosis. The aim of this study was to evaluate the feasibility, safety and efficacy of intracoronary β-radiation in patients at very high risk for recurrence of in-stent restenosis. Methods. We analyzed 42 patients with 50 lesions submitted to catheter-based β-radiation (Beta-Cath System, Novoste Corporation, Norcross, GA, USA) for in-stent restenosis. Thirty-eight lesions were at the second restenosis, 8 at the third, and 4 at the fourth; a diffuse pattern was present in 78{\%}. Results. Balloon angioplasty was performed for 30 lesions (60{\%}) and the cutting balloon technique for 20 (40{\%}). In 12 lesions further 14 stents had to be deployed (28{\%}). The delivery catheter was successfully positioned in 96{\%} of the procedures. The mean dwell time was 179 ± 50 s with a radiation dose ranging from 18.4 to 25.3 Gy, depending on the vessel size. A complete angiographic success without coronary dissection and without any additional stenting after radiation delivery was achieved in 86{\%}. At follow-up (7.2 ± 2.1 months), the overall restenosis rate was 30.4{\%} (14 lesions). A recurrence was detected in 1/11 lesions with initial focal pattern and in 13/39 lesions with initial diffuse pattern. The restenosis rate was higher in patients in whom a geographic miss had occurred (p <0.05 vs lesions without geographic miss) and in those in whom a new stent had been deployed (p <0.05 vs lesions treated without a stent). Conclusions. Brachytherapy reduces the in-stent restenosis rate in patients who are at very high risk of recurrence. The restenosis pattern, geographic miss and new stent deployment seem to be negative prognostic factors for recurrence of restenosis.",
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T1 - Intracoronary β-radiation for the treatment of patients at very high risk for recurrence of in-stent restenosis

T2 - A single center experience

AU - Zavalloni Parenti, Dennis

AU - Marsico, Federica

AU - Tosi, Giovanni

AU - Catalano, Gianpiero

AU - Maiello, Luigi

AU - Milone, Francesco

AU - Carcagnì, Addolorata

AU - Pron, Paolo Giay

AU - Orecchia, Roberto

AU - Presbitero, Patrizia

PY - 2003/3/1

Y1 - 2003/3/1

N2 - Background. Intracoronary brachytherapy has significantly reduced the recurrence of in-stent restenosis. The aim of this study was to evaluate the feasibility, safety and efficacy of intracoronary β-radiation in patients at very high risk for recurrence of in-stent restenosis. Methods. We analyzed 42 patients with 50 lesions submitted to catheter-based β-radiation (Beta-Cath System, Novoste Corporation, Norcross, GA, USA) for in-stent restenosis. Thirty-eight lesions were at the second restenosis, 8 at the third, and 4 at the fourth; a diffuse pattern was present in 78%. Results. Balloon angioplasty was performed for 30 lesions (60%) and the cutting balloon technique for 20 (40%). In 12 lesions further 14 stents had to be deployed (28%). The delivery catheter was successfully positioned in 96% of the procedures. The mean dwell time was 179 ± 50 s with a radiation dose ranging from 18.4 to 25.3 Gy, depending on the vessel size. A complete angiographic success without coronary dissection and without any additional stenting after radiation delivery was achieved in 86%. At follow-up (7.2 ± 2.1 months), the overall restenosis rate was 30.4% (14 lesions). A recurrence was detected in 1/11 lesions with initial focal pattern and in 13/39 lesions with initial diffuse pattern. The restenosis rate was higher in patients in whom a geographic miss had occurred (p <0.05 vs lesions without geographic miss) and in those in whom a new stent had been deployed (p <0.05 vs lesions treated without a stent). Conclusions. Brachytherapy reduces the in-stent restenosis rate in patients who are at very high risk of recurrence. The restenosis pattern, geographic miss and new stent deployment seem to be negative prognostic factors for recurrence of restenosis.

AB - Background. Intracoronary brachytherapy has significantly reduced the recurrence of in-stent restenosis. The aim of this study was to evaluate the feasibility, safety and efficacy of intracoronary β-radiation in patients at very high risk for recurrence of in-stent restenosis. Methods. We analyzed 42 patients with 50 lesions submitted to catheter-based β-radiation (Beta-Cath System, Novoste Corporation, Norcross, GA, USA) for in-stent restenosis. Thirty-eight lesions were at the second restenosis, 8 at the third, and 4 at the fourth; a diffuse pattern was present in 78%. Results. Balloon angioplasty was performed for 30 lesions (60%) and the cutting balloon technique for 20 (40%). In 12 lesions further 14 stents had to be deployed (28%). The delivery catheter was successfully positioned in 96% of the procedures. The mean dwell time was 179 ± 50 s with a radiation dose ranging from 18.4 to 25.3 Gy, depending on the vessel size. A complete angiographic success without coronary dissection and without any additional stenting after radiation delivery was achieved in 86%. At follow-up (7.2 ± 2.1 months), the overall restenosis rate was 30.4% (14 lesions). A recurrence was detected in 1/11 lesions with initial focal pattern and in 13/39 lesions with initial diffuse pattern. The restenosis rate was higher in patients in whom a geographic miss had occurred (p <0.05 vs lesions without geographic miss) and in those in whom a new stent had been deployed (p <0.05 vs lesions treated without a stent). Conclusions. Brachytherapy reduces the in-stent restenosis rate in patients who are at very high risk of recurrence. The restenosis pattern, geographic miss and new stent deployment seem to be negative prognostic factors for recurrence of restenosis.

KW - Coronary stent

KW - Restenosis

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