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Percutaneous coronary intervention followed by intravascular brachytherapy for management of drug-eluting stents in-stent restenosis in patients with complex coronary artery lesions
Journal article   Open access   Peer reviewed

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 and David Lasorda
Journal of contemporary brachytherapy, v 17(6), pp 355-361
01 Dec 2025
DOI: https://doi.org/10.5114/jcb.2025.158502
PMID: 41737508
url
https://doi.org/10.5114/jcb.2025.158502View
Published, Version of Record (VoR)CC BY-NC-SA V4.0,  Open

Abstract

Life Sciences & Biomedicine Radiology, Nuclear Medicine & Medical Imaging Science & Technology Oncology
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.

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