Drug-Eluting Stents Beat Brachytherapy for Restenosis

Researchers find the stents superior to vascular brachytherapy in reducing major cardiac events

MONDAY, March 13 (HealthDay News) -- Sirolimus- or paclitaxel-releasing stents are more effective than vascular brachytherapy for treating restenosis within bare-metal stents, according to two studies released early online March 12 by the Journal of the American Medical Association to coincide with the American College of Cardiology annual conference in Atlanta.

David R. Holmes, Jr., M.D., of Mayo Clinic in Rochester, Minn., and colleagues randomized 384 patients with in-stent restenosis to receive vascular brachytherapy (VBT) or a sirolimus-eluting stent. Major adverse cardiac events occurred in 19.2 percent of the VBT group compared to 10 percent in the sirolimus-eluting stent group. The rate of target lesion revascularization was 19.2 percent in the VBT group compared to 8.5 percent in the sirolimus-eluting stent group.

The study was supported by the Cordis Corporation, a Johnson & Johnson Company.

In the second study, Gregg W. Stone, M.D., of Columbia University Medical Center in New York City, and colleagues randomly assigned 396 patients to undergo angioplasty followed by VBT or paclitaxel-releasing stent implantation. Paclitaxel-eluting stents significantly reduced the nine-month rate of ischemic target vessel revascularization by 40 percent compared with VBT. They also found that paclitaxel-eluting stents reduced the nine-month composite rate of major adverse cardiac events by 43 percent compared with VBT.

The study was funded by Boston Scientific Corp., of Natick, Mass.

"There may remain a small fraction of patients with in-stent restenosis who will be better served with brachytherapy," according to an editorial. "These would include patients with bifurcation restenotic lesions; vessels or lesions with excessive calcification, tortuosity, or angulation; and other scenarios that may make repeat stenting unsuitable or lead to an increased risk of procedure-related ischemic events.

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