Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Intracoronary brachytherapy for the treatment of recurrent drug-eluting stent in-stent restenosis: A systematic review and meta-analysis
Irtqa Ilyas, Ashish Kumar, Devina Adalja, Mariam Shariff, Rupak Desai, Yasar Sattar, Saraschandra Vallabhajosyula, Nageshwara Gullapalli, Rajkumar Doshi
Irtqa Ilyas, Nageshwara Gullapalli, Rajkumar Doshi, Department ofInternal Medicine, University of Nevada Reno School of Medicine, Reno, NV 89509, United States
Ashish Kumar, Mariam Shariff, Department of Critical Care Medicine, Saint John's Medical College Hospital, Bangalore 560034, Karnataka, India
Devina Adalja, Department of Internal Medicine, GMERS Gotri Medical College, Vadodara 380021, Gujarat, India
Rupak Desai, Department of Cardiology, Atlanta VA Medical Center, Decatur, GA 30033, United States
Yasar Sattar, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst, New York, NY 11373, United States
Saraschandra Vallabhajosyula, Interventional Cardiology, Emory University, Atlanta, GA 30322, United States
Author contributions: Ilyas I, Adalja D, Shariff M, Kumar A, Desai R, Sattar Y, Vallabhajosyula S, Doshi R, and Gullapalli N performed the conceptualization, methodology, writing, reviewed and edited the manuscript; Kumar A, Desai R, Sattar Y, Vallabhajosyula S and Doshi R performed the software, formal analysis; Vallabhajosyula S, Gullapalli N and Doshi R supervised the manuscript.
Conflict-of-interest statement: There is no conflict of interest for any of the author in this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 checklist, and the manuscript was prepared and revised according to the PRISMA 2009 checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Rajkumar Doshi, MD, Attending Doctor, Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 W11 Mill St, Reno, NV 89509, United States. raj20490@gmail.com
Received: December 13, 2020
Peer-review started: December 13, 2020
First decision: February 28, 2021
Revised: March 8, 2021
Accepted: March 22, 2021
Article in press: March 22, 2021
Published online: April 26, 2021
ARTICLE HIGHLIGHTS
Research background
There is no established strategy for the management of in-stent restenosis which is common even when using drug eluting stents. There is a resurgence of the use of intracoronary brachytherapy (ICBT) for the treatment of drug eluting stent in-stent restenosis (DES-ISR).
Research motivation
The use of ICBT was common in the late 1990s era. Even with the use of second and third generation drug-eluting stents, in-stent restenosis have remined a significant problem. There have been multiple strategies used to manage this complex problem. Along with other strategies, ICBT has re-emerged as a potential solution.
Research objectives
The main objective was to perform a meta-analysis for patients undergoing ICBT for recurrent DES-ISR and analyze clinically important outcomes.
Research methods
We have reviewed PubMed/MEDLINE, Cochrane and DARE databases to identify studies that used ICBT for the management of in-stent restenosis. We used a random-effect model with DerSimonian & Laird method to calculate summary estimates. Heterogeneity was assessed using I2 statistics.
Research results
We included 6 observational studies in this meta-analysis. Procedural angiographic success following intra-coronary brachytherapy was 99.8%. The incidence of myocardial infarction and all-cause mortality was within acceptable range at 2 years. Incidence of target lesion revascularization (14.1%) at 1-year and (22.7%) at 2-years, respectively.
Research conclusions
Brachytherapy should be one of the preferred approach for recurrent DES-ISR.
Research perspectives
There is an unmet need for randomized control trial comparing brachytherapy vs another drug eluting stent with a longer follow-up.
