Durable clinical benefit following Sr90 Beta irradiation therapy for in-stent XXXX in high-volume community practice.

@entity1 @entity168 @entity256 @entity66
Although randomized clinical trials have demonstrated efficacy of coronary irradiation versus placebo for the treatment of in-stent @entity256 (ISR), durable long-term benefit in community practice is less well defined. From January 1, 2001, through June 30, 2002, consecutive percutaneous coronary intervention (n = 3,869) were analyzed at our center with a total of 330 @entity1 undergoing coronary irradiation for ISR (53, Ir192; 12, P32; 265 Novoste Sr90). Novoste Sr90 was successfully performed in 265 of 270 (98%) of @entity1 attempted by 10 operators. The mean @entity1 age was 63 years (range 35 90) with 55% male (145/265) and 45% female (120/265). ISR anatomic subsets included @entity66 (45/265; 17%), multi-vessel (27/265; 10.0%) and saphenous vein graft (16/265; 6.0%) interventions. At a mean follow-up of 10.5 2.8 ( @entity168 ) months, fifty-three (20%) of the Novoste Sr90 treated @entity1 had returned for symptoms requiring repeat angiography. Of these, 23 @entity1 had repeat percutaneous coronary intervention (PCI) including 2 target site revascularizations (TSR), twelve non-TSR (distinct from the radiated segment of the target vessel), and 9 non-target vessel revascularizations (TVR). Coronary artery bypass surgery was performed in 11 total @entity1 , 4 due to TSR, and 7 due to non-TVR. Clinical TSR was 2.3% (6/265) and TVR was 6.8% (18/265). In conclusion, the Novoste SR90 Beta-Cath System for the treatment of ISR is associated with a high procedural success rate and low TSR and TVR. Revascularization in follow-up is predominantly due to progressive disease outside the radiated segment and aggressive secondary prevention, especially prolonged anti-platelet therapy, appear critical to long-term procedural success.
