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. 2025 Jun 1:244:89-98.
doi: 10.1016/j.amjcard.2025.02.024. Epub 2025 Mar 29.

Outcomes of Intracoronary Brachytherapy for In-Stent Restenosis

Thomas R Basala  1 , Muhmmad S Khalid  2 , Ozgur Selim Ser  3 , Michael Megaly  4 , Matthew Glogoza  5 , Dimitrios Strepkos  3 , Athanasios Rempakos  3 , Michaella Alexandrou  3 , Deniz Mutlu  3 , Pedro Carvalho  3 , Sydney Peng  3 , Olga Mastrodemos  3 , Sandeep Jalli  3 , Judit Karacsonyi  3 , Yader Sandoval  3 , Yale Wang  3 , Patsa Sullivan  3 , David J Monyak  6 , Konstantinos Voudris  3 , Ahmed Al-Ogaili  7 , Bavana V Rangan  3 , M Nicholas Burke  3 , Emmanouil S Brilakis  8
Affiliations

Outcomes of Intracoronary Brachytherapy for In-Stent Restenosis

Thomas R Basala et al. Am J Cardiol. .

Abstract

Because of limited alternative options, intracoronary brachytherapy (ICBT) continues to be used for treating in-stent restenosis (ISR). We examined the indications, characteristics, and outcomes of ICBT in consecutive patients who underwent ICBT for ISR between January 2014 and December 2023 at a tertiary care center. During the study period 343 patients underwent ICBT of 502 lesions. The median patient age was 67 [60, 74] years, 73.4% of the patients were men, 77.3% had prior myocardial infarction, and 49.4% had prior coronary artery bypass graft surgery. The most common target vessel was the right coronary artery (38.7%) and 7.37% of lesions were in bypass grafts (33 saphenous vein grafts, 4 arterial grafts). A diffuse ISR pattern was found in 76.2% of lesions. Among the study lesions, 58.0% had 2 stent layers and 20.6% had 3 or more stent layers. Technical success was achieved in 96.1% of lesions. Follow-up was available for all patients with a mean follow-up of 701.5 days. The 3-year incidence of target lesion failure (TLF), target vessel myocardial infarction, and major adverse cardiac events were 36.4%, 17.2%, and 45.6%, respectively. In multivariable analysis, higher brachytherapy radiation dose was associated with a lower risk for TLF (aHR per 10 Gy: 0.73; 95% CI 0.54-0.93; p = 0.048). Repeat ICBT procedures had a higher incidence of TLF over 3 years compared with lesions treated with ICBT for the first time (log-rank test: p = 0.008). In conclusion, the 3-year incidence of TLF after ICBT is 36.4% and was lower with higher radiation dose and higher in lesions retreated with ICBT.

Keywords: brachytherapy; drug-coated balloon; in-stent restenosis; pci; stent failure.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Thomas Basala reports financial support was provided by University of Michigan Medical School. Yader Sandoval reports a relationship with Abbott Diagnostics that includes: consulting or advisory and speaking and lecture fees. Yader Sandoval reports a relationship with Roche Diagnostics that includes: consulting or advisory and speaking and lecture fees. Yader Sandoval reports a relationship with ZOLL Medical Corporation that includes: consulting or advisory and speaking and lecture fees. Yader Sandoval reports a relationship with Philips that includes: consulting or advisory and speaking and lecture fees. Yader Sandoval reports a relationship with JACC Advances that includes: board membership. Emmanouil S. Brilakis reports a relationship with Abbott Vascular Inc that includes: consulting or advisory and speaking and lecture fees. Emmanouil S. Brilakis reports a relationship with American Heart Association that includes: board membership. Emmanouil S. Brilakis reports a relationship with BIOTRONIK Inc that includes: consulting or advisory and speaking and lecture fees. Emmanouil S. Brilakis reports a relationship with Boston Scientific Corporation that includes: consulting or advisory and speaking and lecture fees. Emmanouil S. Brilakis reports a relationship with Cardiovascular Research and Innovation Foundation that includes: board membership. Emmanouil S. Brilakis reports a relationship with Cordis that includes: consulting or advisory and speaking and lecture fees. Emmanouil S. Brilakis reports a relationship with Cardiovascular Systems Inc that includes: consulting or advisory and speaking and lecture fees. Emmanouil S. Brilakis reports a relationship with Elsevier Inc that includes: consulting or advisory and speaking and lecture fees. Emmanouil S. Brilakis reports a relationship with GE Healthcare that includes: consulting or advisory and speaking and lecture fees. Emmanouil S. Brilakis reports a relationship with IMDS that includes: consulting or advisory and speaking and lecture fees. Emmanouil S. Brilakis reports a relationship with Medtronic that includes: consulting or advisory and speaking and lecture fees. Emmanouil S. Brilakis reports a relationship with Opsens Inc that includes: consulting or advisory and speaking and lecture fees. Emmanouil S. Brilakis reports a relationship with Teleflex Inc that includes: consulting or advisory and speaking and lecture fees. Emmanouil S. Brilakis reports a relationship with Boston Scientific Corporation that includes: funding grants. Emmanouil S. Brilakis reports a relationship with GE Healthcare that includes: funding grants. Emmanouil S. Brilakis reports a relationship with MHI Ventures that includes: equity or stocks. Emmanouil S. Brilakis reports a relationship with Cleerly Health that includes: equity or stocks. Emmanouil S. Brilakis reports a relationship with Stallion Medical that includes: equity or stocks. Emmanouil S. Brilakis reports a relationship with Hippocrates LLC that includes: board membership, employment, and equity or stocks. Yader Sandoval has patent #20210401347 pending to United States Patent and Trademark Office (USPTO). Emmanouil Brilakis is the owner of Hippocrates LLC If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Thomas Basala, Muhmmad Khalid, Ozgur Selim Ser, Michael Megaly, Matthew Glogoza, Dimitrios Strepkos, Athanasios Rempakos, Michaella Alexandrou, Deniz Mutlu, Pedro Carvalho, Sydney Peng, Olga Mastrodemos, Sandeep Jalli, Judit Karacsonyi, Patsa Sullivan, David J. Monyak, Konstantinos Voudris, Ahmed Al-Ogaili, Bavana V Rangan, and M. Nicholas Burke have no disclosures. Yader Sandoval has received consulting/speaker honoraria from Abbott Diagnostics, Roche Diagnostics, Zoll, and Philips; is an associate editor for JACC Advances; and holds Patent 20210401347. Emmanouil S. Brilakis has received consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), Cordis, CSI, Elsevier, GE Healthcare, IMDS, Medtronic, Opsens, and Teleflex; research support: Boston Scientific, GE Healthcare; owner, Hippocrates LLC; shareholder: MHI Ventures, Cleerly Health, Stallion Medical.

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