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Megaly M, Glogoza M, Xenogiannis I, Vemmou E, Nikolakopoulos I, Omer M, Saad M, Willson L, Monyak DJ, Sullivan P, Pershad A, Chavez I, Mooney M, Traverse J, Wang Y, Garcia S, Poulose A, Burke MN, Brilakis ES. Coronary Intravascular Brachytherapy for Recurrent Coronary Drug-Eluting Stent In-Stent Restenosis: A Systematic Review and Meta-Analysis. Cardiovasc Revasc Med 2020; 23:28-35. [PMID: 32883584 DOI: 10.1016/j.carrev.2020.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To examine the outcomes with intravascular brachytherapy (IVBT) in recurrent in-stent restenosis (ISR). BACKGROUND Recurrent ISR can be challenging to treat and IVBT can be used for recurrent ISR but has received limited study. METHODS We performed a systematic review and meta-analysis of five observational studies, including 917 patients (1014 lesions) with recurrent ISR, defined as having at least two prior ISR episodes with previous treatment with a stent, who underwent treatment with IVBT. Outcomes of interest included target vessel revascularization (TVR), myocardial infarction (MI), and all-cause mortality. RESULTS During a mean follow-up of 24 ± 7 months, the incidence of TVR was 29.2% (95% CI 18.0-40.4%). The incidence of MI and all-cause mortality were 4.3% (95% CI 1.7%-6.9%) and 7.3% (95% CI 3.2-11.5%), respectively. At one- and two-years after PCI the incidence of TVR was 17.5% (95% CI 13.6%-21.4%) and 26.7% (95% CI 16.6%-36.9%), respectively and the incidence of MI was 3.1% (95% CI 2-4.2%) and 3.9% (95% CI 1-6.8%), respectively. CONCLUSION Intravascular brachytherapy can be used to treat recurrent ISR, although TVR is needed in approximately one of four patients at two years.
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Affiliation(s)
- Michael Megaly
- Banner University Medical Center, UA College of Medicine-Phoenix, AZ, USA
| | | | | | - Evangelia Vemmou
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | | | | | - Marwan Saad
- Division of Cardiovascular Medicine, The Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | | | - David J Monyak
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | - Patsa Sullivan
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | - Ashish Pershad
- Banner University Medical Center, UA College of Medicine-Phoenix, AZ, USA
| | - Ivan Chavez
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | - Michael Mooney
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | - Jay Traverse
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | - Yale Wang
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | - Santiago Garcia
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | - Anil Poulose
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute at Abbott Northwestern Hospital, USA
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Megaly M, Glogoza M, Xenogiannis I, Vemmou E, Nikolakopoulos I, Willson L, Monyak DJ, Sullivan P, Stanberry L, Sorajja P, Chavez I, Mooney MR, Traverse J, Wang Y, Garcia S, Poulose A, Burke MN, Brilakis E. OUTCOMES OF INTRAVASCULAR BRACHYTHERAPY IN RECURRENT DRUG-ELUTING IN-STENT RESTENOSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31778-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Megaly M, Glogoza M, Xenogiannis I, Vemmou E, Nikolakopoulos I, Willson L, Monyak DJ, Sullivan P, Stanberry L, Sorajja P, Chavez I, Mooney M, Traverse J, Wang Y, Garcia S, Poulose A, Burke MN, Brilakis ES. Outcomes of intravascular brachytherapy for recurrent drug-eluting in-stent restenosis. Catheter Cardiovasc Interv 2020; 97:32-38. [PMID: 31943747 DOI: 10.1002/ccd.28716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/25/2019] [Accepted: 12/29/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To examine the outcomes of vascular brachytherapy (VBT) for recurrent drug-eluting stents (DES) in-stent restenosis (ISR). BACKGROUND Recurrent DES-ISR can be challenging to treat. VBT has been used with encouraging results. METHODS We report the long-term outcomes of patients with recurrent DES-ISR treated with VBT between January 2014 and September 2018 at a tertiary care institution. The main outcome was target lesion failure (TLF), defined as the composite of clinically driven target lesion revascularization (TLR), target lesion myocardial infarction (MI), and target lesion-related cardiac death. Cox proportional hazards analysis was performed to identify variables associated with recurrent TLF. RESULTS During the study period, 116 patients (143 lesions) underwent VBT. Median follow-up was 24.7 (14.5-35.4) months. The incidence of TLR, target-lesion MI, and TLF was 18.9%, 5.6%,and 20.1% at 1 year, and 29.4%, 10.5%, and 32.9% at 2 years.Initial presentation with acute coronary syndrome (ACS) was independently associated with TLF (hazard ratio = 1.975, 95% CI [1.120, 3.485], p = .019). Lesions treated with intravascular ultrasound (IVUS) guidance had a lower incidence of TLR (14.3% vs. 39.6%, log-rank p = .038), and a trend toward lower incidence of TLF (19% vs. 42.6%, log-rank p = .086). CONCLUSIONS VBT can improve the treatment of recurrent DES-ISR, but TLF occurs in approximately one in three patients at 2 years. Initial presentation with ACS was associated with higher TLF and the use of IVUS with a trend for lower incidence of TLF.
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Affiliation(s)
- Michael Megaly
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.,Department of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Matthew Glogoza
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Iosif Xenogiannis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Evangelia Vemmou
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ilias Nikolakopoulos
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Laura Willson
- Department of Radiation Oncology, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - David J Monyak
- Department of Radiation Oncology, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Patsa Sullivan
- Department of Radiation Oncology, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Larissa Stanberry
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ivan Chavez
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Michael Mooney
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Jay Traverse
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Anil Poulose
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
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Blaes AH, Lindgren B, Mulrooney DA, Willson L, Cho LC. Femur fractures after limb-sparing treatment of soft-tissue sarcomas: One institution's experience. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e19601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
In response to needs identified by community nurses in remote and isolated areas in North Argyll, Scotland, a programme of clinical supervision was implemented. The term 'practice support' was chosen by the community nurses for this project. The purpose was to provide peer support to counteract geographical isolation and to facilitate professional development through the use of reflective practice. Practice support was carried out over a period of 9 months. Pre-implementation and post-implementation questionnaires were used to evaluate the project.
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Affiliation(s)
- L Willson
- Mount Royal College, Calgary, Canada
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