Intravascular coronary brachytherapy combined with a drug-coated balloon

Kathleen E. Kearney, Kent Wallner, Minsun Kim, Ravi S. Hira, Edward Y. Kim, Kenta Nakamura, Upendra Parvathaneni, Zachary L. Steinberg, James M. McCabe, William L. Lombardi, Mark L. Phillips, Creighton Don

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Coronary artery disease leads to stenosis of the major cardiac vessels, resulting in ischemia and infarction. Percutaneous intervention (PCI) with balloon angioplasty can re-open stenosed vessels. Drug eluting stents (DES) and intravascular brachytherapy (IVBT) and drug-coated balloons (DCBs) are proven to decrease the likelihood of another restenosis after PCI, but neither is completely effective. Due to the limited long-term effectiveness of IVBT or DCB used separately for salvage PCI, we combined the two in some poor prognosis patients. Methods: Combined IVBT+DCB was intended for a total of 36 patients from 2015-2020. PCI with some combination of ballooning, laser and directional/rotational atherectomy was used to maximally open the stenotic region prior to IVBT+DCB. Beta-radiation brachytherapy for all patients was done with a Novoste Beta-Cath. Lutonix 4.0 x 40 mm paclitaxel-coated balloons (Bard, Murray Hill, NJ) were employed. Results: Overall survival at two years was 88%. Nine patients had follow-up angiograms, all for cardiac symptoms. Time from IVBT+DCB to follow-up angiography ranged from 4 to 33 months. The average months PCI-free interval before brachy therapy was 11.1 mos (95% CI 1.03-23.25) versus 23.3 mos after VBT (23.3 95% CI 12.3-32.3). The mean difference was 11.2 mos (95% CI 1.06-21.4, p < 0.031). None of the follow-up angiographic procedures displayed evidence of what could be interpreted as radiation damage. Conclusions: In this uncontrolled series, IVBT plus DCB appeared to lengthen the ISR-free interval relative to what had been achieved prior to the combined intervention. We view these results as mildly encouraging, worthy of further study.

Original languageEnglish (US)
Pages (from-to)1276-1281
Number of pages6
JournalBrachytherapy
Volume20
Issue number6
DOIs
StatePublished - Nov 1 2021
Externally publishedYes

Keywords

  • Balloon
  • Brachytherapy
  • Coated
  • Coronary
  • Drug
  • Oncology
  • Radiation

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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