Slides

Repeat Brachytherapy for a Total In-Stent Restenosis after Intracoronary Brachytherapy

- Operator : Bon-Kwon Koo

Repeat Brachytherapy for a Total In-Stent Restenosis after Intracoronary Brachytherapy
- Operator : Bon-Kwon Koo, MD, PhD / Myoung-Mook Lee, MD, PhD, Korea
A 61-year old female patient was admitted for routine 2-year follow-up angiography after intracoronary radiation therapy. She had no risk factor for coronary artery disease. Two years ago, the patient had received brachytherapy for a diffuse in-stent restenosis lesion (NIR royal 2.5 X 15 mm) at proximal LAD (Figure 1). The 1st brachytherapy had been successfully performed with a rhenium-188-DTPA filled angioplasty balloon (2.5 X 30 mm, Silky) after rotational atherectomy (Figure 2, Figure 3). Radiation dose was 17.6 Gy at a depth of 1.0 mm into the vessel wall from the balloon-artery interface.
Although she didn’t have chest pain, follow-up coronary angiography showed total occlusion of previous stent (Figure 4). There was a grade 3 collateral flow from RCA. After wiring the lesion with 0.014" Shinobi wire, predilatation was performed with a cutting balloon (2.75 x 10mm, 6 atm). The 2nd brachytherapy was performed with identical method and dosage as the 1st radiation therapy (Figure 5). Six-month follow-up angiogram after 2nd brachytherapy showed no significant luminal narrowing of previous radiation site (Figure 6).

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