Coronary Intravascular Brachytherapy for Recurrent Coronary Drug-Eluting Stent In-Stent Restenosis: A Systematic Review and Meta-Analysis

Objective: To examine the outcomes with intravascular brachytherapy (IVBT) in recurrent in-stent restenosis (ISR).

Background: Recurrent ISR can be challenging to treat and IVBT can be used for recurrent ISR but has received limited study.

Methods: We performed a systematic review and meta-analysis of five observational studies, including 917 patients (1014 lesions) with recurrent ISR, defined as having at least two prior ISR episodes with previous treatment with a stent, who underwent treatment with IVBT. Outcomes of interest included target vessel revascularization (TVR), myocardial infarction (MI), and all-cause mortality.

Results: During a mean follow-up of 24 ± 7 months, the incidence of TVR was 29.2% (95% CI 18.0-40.4%). The incidence of MI and all-cause mortality were 4.3% (95% CI 1.7%-6.9%) and 7.3% (95% CI 3.2-11.5%), respectively. At one- and two-years after PCI the incidence of TVR was 17.5% (95% CI 13.6%-21.4%) and 26.7% (95% CI 16.6%-36.9%), respectively and the incidence of MI was 3.1% (95% CI 2-4.2%) and 3.9% (95% CI 1-6.8%), respectively.

Conclusion: Intravascular brachytherapy can be used to treat recurrent ISR, although TVR is needed in approximately one of four patients at two years.