Banner University Medical Center, UA College of Medicine-Phoenix, AZ, USA.
Abbott Northwestern Hospital, Minneapolis, MN, USA.
Cardiovasc Revasc Med. 2021 Feb;23:28-35. doi: 10.1016/j.carrev.2020.08.035. Epub 2020 Aug 23.
To examine the outcomes with intravascular brachytherapy (IVBT) in recurrent in-stent restenosis (ISR).
Recurrent ISR can be challenging to treat and IVBT can be used for recurrent ISR but has received limited study.
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.
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.
Intravascular brachytherapy can be used to treat recurrent ISR, although TVR is needed in approximately one of four patients at two years.
研究血管内放射治疗（IVBT）在复发性支架内再狭窄（ISR）中的疗效。
复发性 ISR 的治疗具有挑战性，IVBT 可用于治疗复发性 ISR，但相关研究较少。
我们对 5 项观察性研究进行了系统回顾和荟萃分析，共纳入 917 例（1014 处病变）复发性 ISR 患者（定义为至少有 2 次支架内再狭窄病史，且之前接受过支架治疗），这些患者接受了 IVBT 治疗。主要研究终点为靶血管血运重建（TVR）、心肌梗死（MI）和全因死亡率。
平均随访 24±7 个月后，TVR 的发生率为 29.2%（95%CI 18.0%-40.4%）。MI 和全因死亡率的发生率分别为 4.3%（95%CI 1.7%-6.9%）和 7.3%（95%CI 3.2%-11.5%）。PCI 术后 1 年和 2 年时，TVR 的发生率分别为 17.5%（95%CI 13.6%-21.4%）和 26.7%（95%CI 16.6%-36.9%），MI 的发生率分别为 3.1%（95%CI 2-4.2%）和 3.9%（95%CI 1-6.8%）。
IVBT 可用于治疗复发性 ISR，但大约每 4 例患者中就有 1 例在 2 年内需要 TVR。
