Document Detail


Influence of device selection on angiographic outcomes for the treatment of in-stent restenosis. A sub analysis from the Washington Radiation for In-Stent restenosis Trial (WRIST).
MedLine Citation:
PMID:  12025375     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Treatment of in-stent restenosis is still a challenge. Despite promising results obtained with intracoronary brachytherapy (ICB), the ideal strategy of device selection has not been identified. The aim of this study was to evaluate the influence of device selection on ICB for the treatment of instant restenosis. METHODS: The outcomes of 130 patients from the Washington Radiation for In-Stent restenosis Trial (WRIST) were studied. Patients were analyzed on the basis of device selection, prior to randomization to gamma-radiation (n = 65) or placebo (n = 65): balloon angioplasty (PTCA) (n = 15, 12%), rotational atherectomy (RA) (n = 40, 31%), excimer laser coronary angioplasty (ELCA) (n = 28, 22%) or additional stent implantation (n = 47, 36%). RESULTS: PTCA was less frequently used in lesions with prior in-stent restenosis (14.8%, p < 0.05); ELCA was less frequently used in saphenous vein grafts (57.1%, p < 0.05). The procedural outcomes and restenosis rates were similar among groups. In the RA group, patients assigned or Ir192 had a larger minimal lumen diameter (1.6 +/- 0.5 vs 0.9 +/- 0.4 mm, p < 0.05) and lower diameter stenosis (39 +/- 7 vs 65 +/- 16%, p < 0.05) at follow-up angiography and a reduced late loss (0.2 +/- 0.5 v 0.9 +/- 0.5 mm, P < 0.05) and loss index (0 +/- 0.4 vs 0.8 +/- 0.4, p < 0.05) when compared to placebo. The incidence of delayed thrombosis was 7.7% in the ICB and 4.6% in the placebo group (p = 0.71); additional stenting, either alone (relative risk 12.36, 95% confidence interval 1.56 divided by 94.43) or followed by ICB (relative risk 3.80, 95% confidence interval 1.02 divided by 14.27), was correlated with an increased risk of late thrombosis. CONCLUSIONS: ICB reduces the recurrence of in-stent restenosis through a reduction in late loss. In view of the higher risk of delayed thrombosis, additional stenting, either alone or followed by ICB, should be used with caution.
Authors:
Marco Zimarino; Andrew E Ajani; Stefania Marazia; Augusto D Pichard; Lowell F Satler; Raffaele De Caterina; Antonio Barsotti; Ron Waksman
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Italian heart journal : official journal of the Italian Federation of Cardiology     Volume:  3     ISSN:  1129-471X     ISO Abbreviation:  Ital Heart J     Publication Date:  2002 Apr 
Date Detail:
Created Date:  2002-05-23     Completed Date:  2002-11-18     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  100909716     Medline TA:  Ital Heart J     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  256-62     Citation Subset:  IM    
Affiliation:
Vascular Brachytherapy Institute, Cardiology Research Institute, Washington Hospital Center, Washington, DC, USA. emosax@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Balloon, Laser-Assisted
Angioplasty, Transluminal, Percutaneous Coronary
Atherectomy, Coronary
Brachytherapy
Coronary Angiography*
Coronary Restenosis / prevention & control,  radiography,  therapy*
Double-Blind Method
Female
Follow-Up Studies
Humans
Male
Middle Aged
Risk Factors
Saphenous Vein / transplantation
Stents*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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