The development of an effective strategy for management of in-stent restenosis (ISRS) following “bare metal” stenting has proved difficult. Standard percutaneous therapy for ISRS leads to re-restenosis rates above 50% and consequently represents a poor treatment option.¹ At present the “gold standard” treatment for ISRS is vascular brachytherapy (VBT), with re-restenosis rates falling to below 20% in most trials.^2,3 While the use of drug eluting stents (DES) appears to be effective in simple ISRS lesions, the results in complex cases are less impressive.^4,5

At present, however, there are no published data on the clinical utility of VBT in complex native coronary lesions and multivessel disease. We have therefore analysed the procedural details and clinical outcome of patients with complex ISRS treated with intracoronary brachytherapy at our institution.

METHODS

A total of 126 consecutive patients treated at our institution with ISRS from August 2000 to February 2003 were assessed. Cases were deemed complex if:

• there was multi-vessel ISRS or

• ISRS involving a bifurcation, or

• ISRS associated with complete coronary occlusion (no cases of acute/subacute stent thrombosis were included).

Clinical and procedural data were collected prospectively and clinical follow up was by telephone interview at 6, 12, 18, and 24 months.

A total of 39 patients were …