Three-year follow-up after intravascular γ-radiation for in-stent restenosis in saphenous vein grafts

Seung-Woon Rha, Pramod Kuchulakanti, Andrew E. Ajani, Edouard Cheneau, Ellen E. Pinnow, Daniel A. Canos, Rebecca Torguson, Augusto D. Pichard, Lowell F. Satler, Kenneth M. Kent, Steven Ramee, Paul Teirstein, Joseph Lindsay, Ron Waksman

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

The Washington Radiation for In-Stent Restenosis Trial in Saphenous Vein Grafts (SVG WRIST) demonstrated safety and efficacy of intravascular radiation therapy (IRT) for the treatment of in-stent restenosis (ISR) in SVG at 12 months. In this study, we aimed to examine whether the safety and efficacy of IRT is durable up to 36 months. One hundred twenty patients with diffuse ISR in SVG underwent balloon angioplasty, laser or atherectomy ablation, and/or additional stenting. After successful intervention, patients were randomly assigned in a double-blind fashion to intravascular treatment with a ribbon containing either iridium (Ir)-192 (n = 60) or nonradioactive seeds (n = 60). The prescribed dose at 2 mm from the source was either 14 or 15 Gy in vessels 2.5-4.0 mm or 18 Gy in vessels > 4.0 mm in diameter. At 36 months, target lesion revascularization (TLR; 43% vs. 66%; P = 0.02) and target lesion revascularization-major adverse cardiac event (TLR-MACE; 49% vs. 71%; P = 0.02) rates continued to be lower in the IRT group, but both target vessel revascularization (TVR; 59% vs. 71%; P = 0.17) and TVR-MACE (63% vs. 77%; P = 0.11) rates were not. In SVG WRIST, patients with ISR treated with IRT had a marked reduction in the need for repeat TLR at 36 months, with sustained clinical benefit at 3 years despite late recurrences, which were more pronounced in the radiation group.

Original languageEnglish
Pages (from-to)257-262
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume65
Issue number2
DOIs
Publication statusPublished - 2005 Jun 1
Externally publishedYes

Keywords

  • In-stent restenosis
  • Radiation
  • Saphenous vein graft

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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    Rha, S-W., Kuchulakanti, P., Ajani, A. E., Cheneau, E., Pinnow, E. E., Canos, D. A., Torguson, R., Pichard, A. D., Satler, L. F., Kent, K. M., Ramee, S., Teirstein, P., Lindsay, J., & Waksman, R. (2005). Three-year follow-up after intravascular γ-radiation for in-stent restenosis in saphenous vein grafts. Catheterization and Cardiovascular Interventions, 65(2), 257-262. https://doi.org/10.1002/ccd.20372