Late results (>10 years) of intracoronary beta brachytherapy for diffuse in-stent restenosis | Revista Portuguesa de Cardiologia (English edition)

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"paginaInicial" => "609" "paginaFinal" => "616" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ricardo Seabra Gomes, Pedro de Araújo Gonçalves, Rui Campante Teles, Manuel de Sousa Almeida" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Ricardo" "apellidos" => "Seabra Gomes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Pedro" "apellidos" => "de Araújo Gonçalves" "email" => array:1 [ 0 => "paraujogoncalves@yahoo.co.uk" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Rui" "apellidos" => "Campante Teles" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Manuel" "apellidos" => "de Sousa Almeida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidade de Intervenção Cardiovascular (UNICARV), Serviço de Cardiologia, Hospital de Santa Cruz – CHLO, Lisboa, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Avaliação tardia (>10 anos) da braquiterapia intracoronária com radiação beta para reestenose difusa intrastent" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1889 "Ancho" => 2194 "Tamanyo" => 137186 ] ] "descripcion" => array:1 [ "en" => "Survival free of first cardiovascular event (cardiac death, myocardial infarction or target vessel revascularization) (Kaplan-Meier curve)." ] ] ] "textoCompleto" => "IntroductionBefore the drug-eluting stent (DES) era, restenosis due to tissue proliferation in the neointima was the main limitation to wider use of bare-metal stents (BMS) in percutaneous coronary intervention (PCI). In their angiographic classification of in-stent restenosis (ISR), Mehran et al.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> described diffuse ISR as having higher rates of recurrence and need for subsequent revascularization. Of the various methods used to control in-stent neointimal hypoplasia, intracoronary brachytherapy showed the strongest antiproliferative effect<a class="elsevierStyleCrossRefs" href="#bib0010">2–6</a> and the best results, and its safety and efficacy were demonstrated in various randomized trials using gamma and beta radiation.<a class="elsevierStyleCrossRefs" href="#bib0030">6–11</a> Following its approval by the US Food and Drug Administration in November 2000, the technique became established as an adjuvant to balloon angioplasty for the treatment of ISR and was incorporated into the guidelines on PCI.<a class="elsevierStyleCrossRefs" href="#bib0060">12,13</a> However, the long-term efficacy of brachytherapy has been questioned,<a class="elsevierStyleCrossRef" href="#bib0070">14</a> and there have been few studies with long-term follow-up after beta brachytherapy.<a class="elsevierStyleCrossRefs" href="#bib0075">15–20</a>The aim of the present study is to analyze the experience of the only Portuguese center using beta brachytherapy (in 2001) and to assess its late efficacy and safety in long-term follow-up (>10 years).MethodsThe study population consisted of 12 consecutive patients who underwent beta brachytherapy between January and July 2001 for diffuse ISR in BMS, defined as ≥50% stenosis and ≥20 mm in length.Patients’ mean age was 58.6±9.9 years (range 43–77 years), and 11 were male. The main cardiovascular risk factors were dyslipidemia in nine patients (75%), hypertension in seven (58%), and diabetes in five (42%). Six patients (50%) had concomitant peripheral arterial disease. All had chronic stable angina; four (33%) had previous myocardial infarction (MI) and three (25%) had previous coronary artery bypass grafting (CABG). There was multivessel disease in eight patients, and only one had left ventricular dysfunction. It was the first occurrence of ISR in six patients, the second in four, and the third in two. Only one case was proliferative ISR. All patients were under maximal tolerated medication with aspirin, statins, nitrates, beta-blockers, calcium channel blockers and angiotensin-converting enzyme inhibitors (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Quantitative analysis of the coronary angiograms was performed with the CAAS II™ cardiovascular angiographic analysis system, using the diameter of the guiding catheter as a reference. The analysis included the reference vessel diameter, lesion length, degree of stenosis and minimal luminal diameter. Angiographic restenosis was defined as intraluminal ISR of ≥50%. The length of the lesions (40–90 mm) and the small diameter of the vessels treated (mean 2.5 mm) should be noted (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Brachytherapy was performed using a 90Sr/90Y beta radiation source (Novoste Beta-Cath™). Beta radiation was chosen because, unlike gamma radiation, it did not require logistical changes to our catheterization laboratory. A protocol was established with the Francisco Gentil Portuguese Oncology Institute in Lisbon, including radiation therapists and medical physicists. All patients gave their informed consent and the treatment was approved by the ethics committee of Hospital de Santa Cruz.All procedures were performed via femoral access using 8F guide catheters. Following control angiography and confirmation of ISR, the diagnostic catheter was replaced by the angioplasty guiding catheter and the lesion was crossed using a 0.014″ guidewire. The restenosed vessel was dilated with a balloon, the diameter and length of which were selected according to vessel diameter and lesion length. The 5F Beta-Cath™ delivery catheter has three lumens, one for the guidewire, one for delivery of the radiation source, and one to deliver saline solution. All catheters used were 40 mm in length. The catheter was advanced over the guidewire, radiation being applied from the distal to the proximal portion of the lesion, in all cases extending radiation coverage to the adjacent tissue without angiographically detectable disease. One or more applications were performed, depending on lesion length (one application in seven patients, two in three and three in two). Radiation dose and time varied in accordance with predefined tables for vessel and stent diameter (18.4 Gy for diameters ≥2.7 and <3.35 mm with radiation time 215 s and 23.0 Gy for diameters >3.35 and ≤4.00 mm with radiation time 268 s). When necessary, the lesions were redilated using the same balloon catheter. All maneuvers requiring handling of radiation (source, catheter and application) were performed by medical physicists and radiation therapists, while all other steps in the procedure were carried out by cardiologists. Quantitative analysis of angiograms was performed before, during and after the intervention. The initial heparin dose was 5000 U, with 2500 U being administered for each additional hour or according to activated coagulation time, which was monitored regularly. Prophylactic abciximab was administered in 11 of the 12 patients. Mean fluoroscopy time was 10.9±5 min (4.8–24.4) and mean procedural time was 50±16 min (33–79).Angiographic success was defined as <50% final residual stenosis, and clinical success as angiographic success together with absence of clinical complications during hospital stay.Patients’ initial medication was continued, and dual antiplatelet therapy with aspirin and clopidogrel or ticlopidine was added. All patients have been followed regularly up to the present or until death, and control angiography was scheduled in all patients nine months after the intervention.Following the recommendations of the Academic Research Consortium (ARC),<a class="elsevierStyleCrossRef" href="#bib0105">21</a> clinical follow-up considered cardiovascular and all-cause mortality, any MI, any new revascularization, angiographic restenosis, and stent thrombosis according to the ARC's new definition.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> The incidence of major adverse cardiac events (MACE), defined as the combined incidence of cardiac death, MI and urgent target vessel revascularization (TVR), was also assessed.Statistical analysisPatients were analyzed according to continuous and categorical variables. Categorical variables were characterized in terms of absolute and relative frequencies. The central tendency and distribution of continuous variables were estimated by sample mean and standard deviation. Event-free survival was analyzed using Kaplan-Meier curves.The statistical analysis was performed using SPSS version 19.0.0.2.ResultsIn all cases there was both clinical and angiographic success. The degree of stenosis decreased from 64.4±16.9 to 25.9±10.3% and minimal luminal diameter increased from 1.0±0.12 to 2.18±0.32 mm. No clinical events were recorded during hospital stay.At nine-month follow-up, only one patient still had angina; restenosis was detected and the patient subsequently underwent CABG.Follow-up was achieved in all patients, for a mean of 10.9±2.5 years. During this period, 19 events occurred in seven patients (<a class="elsevierStyleCrossRefs" href="#tbl0015">Tables 3 and 4</a>). Three patients (25%) died, one from cancer at 90 months after the intervention, one at 132 months of sepsis (neither having suffered any cardiac event after brachytherapy), and one (8.3%) from sudden cardiac death at 43 months, a few days after undergoing PCI and implantation of two DES in a different vessel from that treated by brachytherapy.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>At 120 months after brachytherapy, one patient (8.3%) suffered ST-segment elevation myocardial infarction (STEMI) due to stent thrombosis in a non-target vessel and underwent successful primary PCI.Five patients (42%) underwent 15 revascularizations, at least one of the target vessel (a total of nine), mainly in the first two years, including four patients (33.3%) who underwent CABG.The first TVR occurred on average 12±4.5 months after brachytherapy (9–21 months). Of the five patients who underwent TVR, in three cases this followed scheduled elective angiography that revealed restenosis of the target vessel, two of the patients being asymptomatic.There was one definite stent thrombosis, in a non-target vessel (8.3%), 120 months after brachytherapy, in an individual who three months previously had undergone drug-eluting balloon angioplasty of a previously implanted DES. One patient (8.3%) had a probable stent thrombosis, identified after sudden cardiac death following revascularization of a non-target vessel 45 months after brachytherapy. No cases of possible stent thrombosis, or of definite or probable stent thrombosis in vessels treated by brachytherapy, were identified.At 10-year follow-up, the incidence of MACE was 16.6% (two patients): one sudden cardiac death and one non-fatal STEMI. No patient required urgent TVR.Control coronary angiography to screen for restenosis was performed on average 271.6±50.6 days after brachytherapy in the 11 patients who agreed to undergo the exam. The rate of angiographic restenosis in these patients was 27% (three patients); asymptomatic occlusion was detected in two cases (18%).Cardiovascular event-free survival at 10 years was 42% (five patients) (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>DiscussionThis article presents the initial and long-term results of the single and limited experience of intracoronary brachytherapy for the treatment of diffuse BMS ISR in Portugal.The small number of patients means that conclusions cannot be drawn concerning the value of brachytherapy compared to other techniques used at the time to treat ISR. However, the long follow-up affords an opportunity to increase our knowledge of the late effects of intracoronary radiation.When brachytherapy was introduced in Portugal, the technique was the best option for treating ISR, which had been shown to be the main obstacle to wider use of BMS in certain situations, such as long lesions, recurrent restenosis and in diabetic patients. Various studies demonstrated its short-term safety and efficacy and advantages over pharmacological therapy, balloon dilatation, cutting balloon, rotational atherectomy, laser coronary angioplasty, and stent-in-stent.<a class="elsevierStyleCrossRefs" href="#bib0010">2–11,22</a> Concerns about the technique focused on three problems: (1) ‘geographic miss’, by which radiation does not cover the distal and proximal ends of the stent, leading to restenosis; (2) stent thrombosis; and (3) late restenosis of the target vessel treated by brachytherapy, known as ‘late catch-up’. In our experience, the first two problems were solved by using a 40-mm delivery catheter with a pullback technique, and by prescribing dual antiplatelet therapy (thienopyridines and aspirin) for all patients at least until the control angiogram. The long follow-up period may clarify the risk and extent of late restenosis and stent thrombosis in treated segments.There were no immediate complications, either clinical or vessel-related, in any of the patients, and quantitative angiography showed excellent early results.The rate of restenosis on control angiography at nine months (27%) in our study is similar to that reported in the literature. In randomized trials of beta radiation for ISR, the mean restenosis rate at 6–9 months was 30% (26%–34%).<a class="elsevierStyleCrossRefs" href="#bib0045">9–11</a> A surprising finding was two cases (18%) of occlusive target vessel restenosis, despite dual antiplatelet therapy, in patients who did not suffer acute coronary syndrome, and were in fact asymptomatic. In a review by Waksman et al.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> of 473 patients treated by beta and gamma brachytherapy and who received only one month of dual antiplatelet therapy, late occlusion occurred in 9.1%, and only 7% of these were asymptomatic, while 43% had MI and 50% presented unstable angina. The possibility of late restenosis after brachytherapy for ISR has been demonstrated in studies with longer follow-up (up to five years), frequently necessitating late TVR.<a class="elsevierStyleCrossRefs" href="#bib0080">16,17</a>In our study, with a mean 10-year follow-up, the incidence of MACE was 16.6%. This figure is low considering the severity of the patients treated and the long follow-up period. In studies with follow-up of up to one year, the mean rate of MACE was 23% (15%–34%).<a class="elsevierStyleCrossRefs" href="#bib0045">9–11</a> In the only published study with a 10-year follow-up (by the Thoraxcenter, Rotterdam<a class="elsevierStyleCrossRef" href="#bib0100">20</a>), in 124 patients treated by brachytherapy for ISR, death from any cause was 16% and death or non-fatal MI was 25%. The combination of all-cause death, any MI and any revascularization was observed in 70% of these patients, mainly new TVR (47%) between five months and two years of follow-up. Late catch-up following beta brachytherapy was mainly seen in unstented (de novo) lesions.Despite concerns regarding increased incidence of acute coronary events following brachytherapy, only one patient (8.3%) in this long follow-up suffered acute coronary syndrome, a complication of previous PCI in another vessel. The only cardiac death was late, and occurred almost immediately after complex PCI in a non-target vessel. It can be fairly confidently assumed that these events cannot be attributed to brachytherapy.In our center, 42% of the patients (n=5) required multiple (n=9) revascularizations of vessels treated by brachytherapy. This is a high proportion compared to the current efficacy of DES, as demonstrated by trials comparing the two approaches.<a class="elsevierStyleCrossRefs" href="#bib0120">24–28</a> However, the complexity of our study population should be borne in mind: 50% with more than one previous restenosis of the treated segment, 67% with multivessel disease, 42% with diabetes and 50% with peripheral arterial disease.The fact that control angiography was scheduled for nine months may have affected the rate of new TVR observed in our study. The phenomenon of ‘oculostenotic reflex’ has been recognized since the Benestent II study.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> Of the five patients who underwent TVR, four had restenosis on angiography but no angina or positive ischemia test and thus the procedure was not ischemia-driven.The demonstrated efficacy of DES in treating ISR has reduced the use of brachytherapy for this purpose. In a meta-analysis of randomized studies comparing first-generation DES (sirolimus and paclitaxel) with balloon angioplasty or brachytherapy for treatment of ISR, there was a 65% reduction in TVR and 64% reduction in angiographic restenosis with DES compared to balloon angioplasty or brachytherapy, with no difference in the incidence of death or MI, in a follow-up of 9–12 months.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> In the TAXUS V ISR trial,<a class="elsevierStyleCrossRef" href="#bib0125">25</a> placlitaxel-eluting stents significantly reduced the need for ischemia-driven TVR compared to beta brachytherapy (18.1% vs. 27.5%, p=0.03) in a two-year follow-up. The SISR trial<a class="elsevierStyleCrossRef" href="#bib0130">26</a> compared sirolimus-eluting stents and beta or gamma brachytherapy; at three years, the incidence of TVR was not significantly lower with DES (20.8% vs. 29.6%, p=0.073). At the five-year follow-up of the same study, TVR rates remained similar (24.7% with sirolimus-eluting stents vs. 31.2% with brachytherapy, p=0.179).<a class="elsevierStyleCrossRef" href="#bib0135">27</a> A more recent trial by Wiemer et al.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> comparing beta brachytherapy and sirolimus-eluting stents in a three-year follow-up showed that the TVR rate with brachytherapy at six months (10.4%) (vs. 2.3% with stents, p=0.25) increased to 46.7% (vs. 11.6% with stents, p<0.0001) at three years.One important point is that of the five patients who underwent TVR, this was by CABG in three, and these patients had no further target vessel-related events in the rest of follow-up. By contrast, the two patients implanted with DES both suffered clinical restenosis, one of whom underwent CABG and the other suffered sudden death following PCI of a non-target vessel. It should however be pointed out that there was no significant occlusive disease in the anterior descending artery in these two patients.Brachytherapy has recently resurfaced as an option for the treatment of restenosis of DES, but it is rarely used.<a class="elsevierStyleCrossRef" href="#bib0150">30</a>In conclusion, in our limited experience, intracoronary brachytherapy to treat diffuse restenosis of BMS is safe, with acceptable rates of angiographic restenosis at nine months and MACE at 10 years, bearing in mind the characteristics of the population treated. Although the number of TVRs was high, they were required in only five patients, while 41% of patients were event-free at the end of the follow-up period, confirming the long-term safety of the procedure.LimitationsThe authors acknowledge the following limitations to the present study:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">(1)It was a retrospective, observational study in a single center, with a small patient sample.</li><li class="elsevierStyleListItem" id="lsti0010">(2)There was no control group, the results being interpreted by comparison with those in the literature.</li><li class="elsevierStyleListItem" id="lsti0015">(3)The patients included were a highly selected subgroup of considerable clinical and angiographic complexity followed over the course of 10 years, which should be borne in mind when interpreting the rate of clinical events recorded during follow-up.</li><li class="elsevierStyleListItem" id="lsti0020">(4)Since this was our center's initial experience with this technique, the results inevitably reflect the learning curve associated with any new procedure.</li><li class="elsevierStyleListItem" id="lsti0025">(5)Procedures performed 10 years ago may not reflect current practice, which will have been influenced by changes in therapeutic strategies, available devices, and the evidence base.</li><li class="elsevierStyleListItem" id="lsti0030">(6)The control angiography scheduled for all patients, irrespective of evidence of ischemia, may have overestimated the need for TVR.</li></ul>Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:2 [ "identificador" => "xres380881" "titulo" => array:6 [ 0 => "Abstract" 1 => "Introduction" 2 => "Objective" 3 => "Methods" 4 => "Results" 5 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec359699" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres380880" "titulo" => array:6 [ 0 => "Resumo" 1 => "Introdução" 2 => "Objetivo" 3 => "População e métodos" 4 => "Resultados" 5 => "Conclusões" ] ] 3 => array:2 [ "identificador" => "xpalclavsec359698" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Limitations" ] 9 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "xack100841" "titulo" => "Acknowledgments" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-11-19" "fechaAceptado" => "2014-02-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec359699" "palabras" => array:4 [ 0 => "Beta radiation" 1 => "Brachytherapy" 2 => "Restenosis" 3 => "Coronary disease" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec359698" "palabras" => array:4 [ 0 => "Radiação beta" 1 => "Braquiterapia" 2 => "Restenose" 3 => "Doença coronária" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "IntroductionUntil the development of drug-eluting stents (DES), diffuse in-stent restenosis (ISR) was the main limitation of bare-metal stents in percutaneous coronary intervention (PCI). Among the different treatments available, intracoronary brachytherapy (BT) emerged as one of the most promising, although it was almost abandoned with the increasing use of DES. ObjectiveTo assess the Portuguese experience with 90Sr/90Y beta brachytherapy for the treatment of diffuse ISR regarding long-term (>10 years) major adverse cardiac events (MACE) and angiographic restenosis. MethodsThis single-center, retrospective, observational study included 12 consecutive patients treated between January and June 2001, mean age 58.6±9.9 years (range 43–77 years), 11 male. All had chronic stable angina, 75% had dyslipidemia, 58% had hypertension, 50% had peripheral arterial disease, 42% had diabetes and 50% had multivessel disease. Recurrent ISR was present in half of the patients and 11 had normal left ventricular function. After balloon dilatation, BT was performed using an 90Sr/90Y (Novoste Beta-Cath™) beta radiation source. All patients remained under dual antiplatelet therapy until scheduled nine-month follow-up angiography. Patients were followed for the occurrence of death (all-cause and cardiovascular), non-fatal myocardial infarction (MI), revascularization, stent thrombosis and angiographic restenosis. MACE were defined as the combined incidence of cardiac death, MI and urgent target vessel revascularization. ResultsIn all cases there was both clinical and angiographic success. In a mean follow-up of 10.9±2.5 years, 19 events occurred in seven patients: death in three (25%), only one cardiac (8.3%); ST-elevation MI in one (related to a non-target vessel) (8.3%); and 15 revascularizations in five (42%), of which nine were of the target vessel (mainly in the first two years). There was only one case of probable stent thrombosis. Angiographic restenosis at nine months was 27% (three out of 11 patients), of which two were total occlusions. Ten-year MACE-free survival was 42% (5 patients). ConclusionsIntracoronary beta brachytherapy for the treatment of diffuse ISR in this small cohort of patients proved to be safe and efficacious, with no late adverse events related to intracoronary radiation." ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "IntroduçãoNo advento dos stents eluidores de fármaco (DES), a reestenose difusa (>20 mm) intrastent (RDIS) constituía a principal limitação ao uso de stents metálicos na intervenção coronária (PCI). Das várias soluções propostas para o seu tratamento, a braquiterapia intracoronária (BT) revelou-se uma das mais eficazes, sendo praticamente abandonada após a introdução dos DES. ObjetivoAvaliar os resultados clínicos a longo prazo (>10 anos) do uso de BT beta com 90Sr/Y90 para o tratamento RDIS, em termos de eventos cardíacos major (MACE) e reestenose angiográfica. População e métodosEstudo retrospetivo observacional de centro único incluindo 12 doentes (dts) consecutivos entre janeiro e julho de 2001, 11 homens, com a idade média de 58,6±9,9 anos (43-77 anos). Todos tinham angor estável. Os principais fatores de risco eram dislipidemia (75%), HTA (58%), doença arterial periférica (50%) e diabetes (42%). Havia doença multivaso em seis dts, tratava-se da 2.a ou 3.a reestenose em seis dts e a função ventricular era normal em 11. A BT foi feita após dilatação com balão, usando a fonte emissora de radiação beta 90Sr/Y90 (Beta-Cath™/Novoste). Todos permaneceram sob dupla antiagregação pelo menos até à angiografia de controlo, programada para todos aos nove meses. Foi considerada a ocorrência de morte global e cardiovascular, enfarte do miocárdio não fatal (EAM), revascularização coronária, trombose de stent e reestenose angiográfica. Foi avaliada a incidência do evento hierárquico combinado (MACE) de: morte cardiovascular, EAM, revascularização coronária urgente do vaso alvo (TVRurg). ResultadosVerificou-se sucesso angiográfico e clínico em 100% dos casos.No seguimento médio de 10,9±2,5 anos, ocorreram 19 eventos em sete dts: morte em três dts (25%), apenas uma cardíaca (8,3%), EAM com elevação de ST (vaso não alvo) num dt (8,3%) e 15 novas revascularizações em cinco dts (42%): nove relacionadas com o vaso alvo (sobretudo nos primeiros dois anos). Apenas se verificou uma trombose de stent, provável. A reestenose angiográfica aos nove meses de seguimento foi de 27% (3/11 dts) com duas oclusões. A taxa de sobrevivência livre de MACE aos dez anos foi de 42% (cincodts). ConclusõesA braquiterapia com radiação beta para RDIS, neste pequeno grupo de dts, demonstrou-se eficaz e segura, sem eventos tardios atribuíveis à radiação intracoronária." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Seabra Gomes R, de Araújo Gonçalves P, Campante Teles R, et al. Avaliação tardia (>10 anos) da braquiterapia intracoronária com radiação beta para reestenose difusa intrastent. Rev Port Cardiol. 2014;33:609–616." ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1889 "Ancho" => 2194 "Tamanyo" => 137186 ] ] "descripcion" => array:1 [ "en" => "Survival free of first cardiovascular event (cardiac death, myocardial infarction or target vessel revascularization) (Kaplan-Meier curve)." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "ACE: angiotensin-converting enzyme; CABG: coronary artery bypass grafting; LV: left ventricular; MI: myocardial infarction; PAD: peripheral arterial disease; PCI: percutaneous coronary intervention." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.6±9.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (92) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Risk factors</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (42) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyslipidemia, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (58) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PAD, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smoking, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (17) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">History</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MI, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (33) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CABG, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical presentation</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stable angina, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive ischemia test, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (83) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multivessel disease, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (67) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preserved LV function, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (92) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Indication for PCI</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First restenosis, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Second restenosis, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (33) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Third restenosis, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (17) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medication before intervention</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aspirin, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Statins, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Beta-blockers, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Calcium channel blockers, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ACE inhibitors, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (58) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nitrates, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (83) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab580147.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Baseline characteristics of the study population." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Target vessel n (%)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anterior descending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (33) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Circumflex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (17) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right coronary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type of stent (total 20), n (%)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ACS MULTI-LINK™ TETRA (Guidant/Advanced Cardiovascular Systems) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (40) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bx Velocity™ (Cordis, Johnson & Johnson) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (35) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AVE GFX-2™ (Arterial Vascular Engineering) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (10) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AVE S670™ (Arterial Vascular Engineering) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NIROYAL™ (Medinol/Scimed Life Systems) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bx Velocity™ heparin-coated stent (Cordis, Johnson & Johnson) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Quantitative analysis</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean reference vessel diameter (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.56±0.58 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean minimal luminal diameter (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0±0.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean degree of stenosis (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.4±16.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean lesion length (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.9±19.5 (40–90 mm) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab580146.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the lesions treated." ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean follow-up (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.9±2.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients with events \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">n (%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MACE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (16.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiac death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (8.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (8.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urgent TVR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">All-cause death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TVR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (41.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Any revascularization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (41.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Definite stent thrombosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (8.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probable stent thrombosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (8.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Possible stent thrombosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Events related to the vessel treated by brachytherapy (n)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiac death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Angiographic restenosis at nine months<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total TVR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients with at least one TVR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total TVR by CABG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab580149.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Of the 12 patients treated, only 11 underwent scheduled nine-month control angiography. CABG: coronary artery bypass grafting; MACE: major adverse cardiac events; MI: myocardial infarction; TVR: target vessel revascularization." ] ] ] "descripcion" => array:1 [ "en" => "Outcomes." ] ] 4 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "CABG: coronary artery bypass grafting; DES: drug-eluting stent; FUP: follow-up; ISR: in-stent restenosis at nine months; NTVR: non-target vessel revascularization; Revasc: revascularization at nine months; ST: stent thrombosis; STEMI: ST-segment elevation myocardial infarction; TVR: target vessel revascularization." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient no. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Clinical status at nine months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">ISR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Revasc \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">EventMonths FUP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">EventMonths FUP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">EventMonths FUP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">EventMonths FUP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">EventMonths FUP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Clinical statusMonths FUP \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asymptomatic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Died (cancer)90 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asymptomatic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes(occlusion) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TVR(CABG)23 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asymptomatic149 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asymptomatic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NTVR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NTVR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TVR(CABG)21 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NTVR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NTVR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">STEMISTNTVR120 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asymptomatic145 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asymptomatic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes(occlusion) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TVR9 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TVR(DES)13 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TVR(DES)19 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TVR(CABG)35 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asymptomatic140 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asymptomatic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TVR9 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TVR(DES)30 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NTVR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MSC43 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sudden cardiac death43 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asymptomatic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Angiography not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Died (sepsis)132 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Angina \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TVR(CABG)14 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asymptomatic \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab580148.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Description of events." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Angiographic patterns 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De Labriolle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1540-8183.2008.00414.x" "Revista" => array:6 [ "tituloSerie" => "J Interv Cardiol" "fecha" => "2008" "volumen" => "21" "paginaInicial" => "528" "paginaFinal" => "534" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18973502" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack100841" "titulo" => "Acknowledgments" "texto" => "The authors are grateful to SOCIME Medical, in the person of Dr. Paulo Amaro, for their provision of the material used in beta brachytherapy. They also thank the Francisco Gentil Portuguese Oncology Institute for its assistance in putting together the multidisciplinary team (radiation therapists L. Jorge and M. Roldão, and medical physicists N. Teixeira and P. Ferreira) and for storing the radioactive source, and Bristol Myers Squibb Farmacêutica Lda. for supplying clopidogrel to all patients up to the nine-month control angiogram. Finally we thank all the physicians, nurses, technicians and secretarial staff of the Cardiology Department of Hospital de Santa Cruz, particularly the Cardiac and Vascular Intervention Unit, for their assistance in the brachytherapy procedures." 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Original Article

Late results (>10 years) of intracoronary beta brachytherapy for diffuse in-stent restenosis

Avaliação tardia (>10 anos) da braquiterapia intracoronária com radiação beta para reestenose difusa intrastent

Ricardo Seabra Gomesa, Pedro de Araújo Gonçalvesa,b,

Corresponding author

paraujogoncalves@yahoo.co.uk

Corresponding author.

, Rui Campante Telesa, Manuel de Sousa Almeidaa

a Unidade de Intervenção Cardiovascular (UNICARV), Serviço de Cardiologia, Hospital de Santa Cruz – CHLO, Lisboa, Portugal

b Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Before the drug-eluting stent &#40;DES&#41; era&#44; restenosis due to tissue proliferation in the neointima was the main limitation to wider use of bare-metal stents &#40;BMS&#41; in percutaneous coronary intervention &#40;PCI&#41;&#46; In their angiographic classification of in-stent restenosis &#40;ISR&#41;&#44; Mehran et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> described diffuse ISR as having higher rates of recurrence and need for subsequent revascularization&#46; Of the various methods used to control in-stent neointimal hypoplasia&#44; intracoronary brachytherapy showed the strongest antiproliferative effect<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;6</span></a> and the best results&#44; and its safety and efficacy were demonstrated in various randomized trials using gamma and beta radiation&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;11</span></a> Following its approval by the US Food and Drug Administration in November 2000&#44; the technique became established as an adjuvant to balloon angioplasty for the treatment of ISR and was incorporated into the guidelines on PCI&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> However&#44; the long-term efficacy of brachytherapy has been questioned&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and there have been few studies with long-term follow-up after beta brachytherapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;20</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">The aim of the present study is to analyze the experience of the only Portuguese center using beta brachytherapy &#40;in 2001&#41; and to assess its late efficacy and safety in long-term follow-up &#40;&#62;10 years&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">The study population consisted of 12 consecutive patients who underwent beta brachytherapy between January and July 2001 for diffuse ISR in BMS&#44; defined as &#8805;50&#37; stenosis and &#8805;20 mm in length&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Patients&#8217; mean age was 58&#46;6&#177;9&#46;9 years &#40;range 43&#8211;77 years&#41;&#44; and 11 were male&#46; The main cardiovascular risk factors were dyslipidemia in nine patients &#40;75&#37;&#41;&#44; hypertension in seven &#40;58&#37;&#41;&#44; and diabetes in five &#40;42&#37;&#41;&#46; Six patients &#40;50&#37;&#41; had concomitant peripheral arterial disease&#46; All had chronic stable angina&#59; four &#40;33&#37;&#41; had previous myocardial infarction &#40;MI&#41; and three &#40;25&#37;&#41; had previous coronary artery bypass grafting &#40;CABG&#41;&#46; There was multivessel disease in eight patients&#44; and only one had left ventricular dysfunction&#46; It was the first occurrence of ISR in six patients&#44; the second in four&#44; and the third in two&#46; Only one case was proliferative ISR&#46; All patients were under maximal tolerated medication with aspirin&#44; statins&#44; nitrates&#44; beta-blockers&#44; calcium channel blockers and angiotensin-converting enzyme inhibitors &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Quantitative analysis of the coronary angiograms was performed with the CAAS II&#8482; cardiovascular angiographic analysis system&#44; using the diameter of the guiding catheter as a reference&#46; The analysis included the reference vessel diameter&#44; lesion length&#44; degree of stenosis and minimal luminal diameter&#46; Angiographic restenosis was defined as intraluminal ISR of &#8805;50&#37;&#46; The length of the lesions &#40;40&#8211;90 mm&#41; and the small diameter of the vessels treated &#40;mean 2&#46;5 mm&#41; should be noted &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Brachytherapy was performed using a <span class="elsevierStyleSup">90</span>Sr&#47;<span class="elsevierStyleSup">90</span>Y beta radiation source &#40;Novoste Beta-Cath&#8482;&#41;&#46; Beta radiation was chosen because&#44; unlike gamma radiation&#44; it did not require logistical changes to our catheterization laboratory&#46; A protocol was established with the Francisco Gentil Portuguese Oncology Institute in Lisbon&#44; including radiation therapists and medical physicists&#46; All patients gave their informed consent and the treatment was approved by the ethics committee of Hospital de Santa Cruz&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">All procedures were performed via femoral access using 8F guide catheters&#46; Following control angiography and confirmation of ISR&#44; the diagnostic catheter was replaced by the angioplasty guiding catheter and the lesion was crossed using a 0&#46;014&#8243; guidewire&#46; The restenosed vessel was dilated with a balloon&#44; the diameter and length of which were selected according to vessel diameter and lesion length&#46; The 5F Beta-Cath&#8482; delivery catheter has three lumens&#44; one for the guidewire&#44; one for delivery of the radiation source&#44; and one to deliver saline solution&#46; All catheters used were 40 mm in length&#46; The catheter was advanced over the guidewire&#44; radiation being applied from the distal to the proximal portion of the lesion&#44; in all cases extending radiation coverage to the adjacent tissue without angiographically detectable disease&#46; One or more applications were performed&#44; depending on lesion length &#40;one application in seven patients&#44; two in three and three in two&#41;&#46; Radiation dose and time varied in accordance with predefined tables for vessel and stent diameter &#40;18&#46;4 Gy for diameters &#8805;2&#46;7 and &#60;3&#46;35 mm with radiation time 215 s and 23&#46;0 Gy for diameters &#62;3&#46;35 and &#8804;4&#46;00 mm with radiation time 268 s&#41;&#46; When necessary&#44; the lesions were redilated using the same balloon catheter&#46; All maneuvers requiring handling of radiation &#40;source&#44; catheter and application&#41; were performed by medical physicists and radiation therapists&#44; while all other steps in the procedure were carried out by cardiologists&#46; Quantitative analysis of angiograms was performed before&#44; during and after the intervention&#46; The initial heparin dose was 5000 U&#44; with 2500 U being administered for each additional hour or according to activated coagulation time&#44; which was monitored regularly&#46; Prophylactic abciximab was administered in 11 of the 12 patients&#46; Mean fluoroscopy time was 10&#46;9&#177;5 min &#40;4&#46;8&#8211;24&#46;4&#41; and mean procedural time was 50&#177;16 min &#40;33&#8211;79&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Angiographic success was defined as &#60;50&#37; final residual stenosis&#44; and clinical success as angiographic success together with absence of clinical complications during hospital stay&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patients&#8217; initial medication was continued&#44; and dual antiplatelet therapy with aspirin and clopidogrel or ticlopidine was added&#46; All patients have been followed regularly up to the present or until death&#44; and control angiography was scheduled in all patients nine months after the intervention&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Following the recommendations of the Academic Research Consortium &#40;ARC&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> clinical follow-up considered cardiovascular and all-cause mortality&#44; any MI&#44; any new revascularization&#44; angiographic restenosis&#44; and stent thrombosis according to the ARC&#39;s new definition&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> The incidence of major adverse cardiac events &#40;MACE&#41;&#44; defined as the combined incidence of cardiac death&#44; MI and urgent target vessel revascularization &#40;TVR&#41;&#44; was also assessed&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Patients were analyzed according to continuous and categorical variables&#46; Categorical variables were characterized in terms of absolute and relative frequencies&#46; The central tendency and distribution of continuous variables were estimated by sample mean and standard deviation&#46; Event-free survival was analyzed using Kaplan-Meier curves&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The statistical analysis was performed using SPSS version 19&#46;0&#46;0&#46;2&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">In all cases there was both clinical and angiographic success&#46; 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a few days after undergoing PCI and implantation of two DES in a different vessel from that treated by brachytherapy&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">At 120 months after brachytherapy&#44; one patient &#40;8&#46;3&#37;&#41; suffered ST-segment elevation myocardial infarction &#40;STEMI&#41; due to stent thrombosis in a non-target vessel and underwent successful primary PCI&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Five patients &#40;42&#37;&#41; underwent 15 revascularizations&#44; at least one of the target vessel &#40;a total of nine&#41;&#44; mainly in the first two years&#44; including four patients &#40;33&#46;3&#37;&#41; who underwent CABG&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The first TVR occurred on average 12&#177;4&#46;5 months after brachytherapy &#40;9&#8211;21 months&#41;&#46; Of the five patients who underwent TVR&#44; in three cases this followed scheduled elective angiography that revealed restenosis of the target vessel&#44; two of the patients being asymptomatic&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">There was one definite stent thrombosis&#44; in a non-target vessel &#40;8&#46;3&#37;&#41;&#44; 120 months after brachytherapy&#44; in an individual who three months previously had undergone drug-eluting balloon angioplasty of a previously implanted DES&#46; One patient &#40;8&#46;3&#37;&#41; had a probable stent thrombosis&#44; identified after sudden cardiac death following revascularization of a non-target vessel 45 months after brachytherapy&#46; No cases of possible stent thrombosis&#44; or of definite or probable stent thrombosis in vessels treated by brachytherapy&#44; were identified&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">At 10-year follow-up&#44; the incidence of MACE was 16&#46;6&#37; &#40;two patients&#41;&#58; one sudden cardiac death and one non-fatal STEMI&#46; No patient required urgent TVR&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Control coronary angiography to screen for restenosis was performed on average 271&#46;6&#177;50&#46;6 days after brachytherapy in the 11 patients who agreed to undergo the exam&#46; The rate of angiographic restenosis in these patients was 27&#37; &#40;three patients&#41;&#59; asymptomatic occlusion was detected in two cases &#40;18&#37;&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Cardiovascular event-free survival at 10 years was 42&#37; &#40;five patients&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">This article presents the initial and long-term results of the single and limited experience of intracoronary brachytherapy for the treatment of diffuse BMS ISR in Portugal&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The small number of patients means that conclusions cannot be drawn concerning the value of brachytherapy compared to other techniques used at the time to treat ISR&#46; However&#44; the long follow-up affords an opportunity to increase our knowledge of the late effects of intracoronary radiation&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">When brachytherapy was introduced in Portugal&#44; the technique was the best option for treating ISR&#44; which had been shown to be the main obstacle to wider use of BMS in certain situations&#44; such as long lesions&#44; recurrent restenosis and in diabetic patients&#46; Various studies demonstrated its short-term safety and efficacy and advantages over pharmacological therapy&#44; balloon dilatation&#44; cutting balloon&#44; rotational atherectomy&#44; laser coronary angioplasty&#44; and stent-in-stent&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;11&#44;22</span></a> Concerns about the technique focused on three problems&#58; &#40;1&#41; &#8216;geographic miss&#8217;&#44; by which radiation does not cover the distal and proximal ends of the stent&#44; leading to restenosis&#59; &#40;2&#41; stent thrombosis&#59; and &#40;3&#41; late restenosis of the target vessel treated by brachytherapy&#44; known as &#8216;late catch-up&#8217;&#46; In our experience&#44; the first two problems were solved by using a 40-mm delivery catheter with a pullback technique&#44; and by prescribing dual antiplatelet therapy &#40;thienopyridines and aspirin&#41; for all patients at least until the control angiogram&#46; The long follow-up period may clarify the risk and extent of late restenosis and stent thrombosis in treated segments&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">There were no immediate complications&#44; either clinical or vessel-related&#44; in any of the patients&#44; and quantitative angiography showed excellent early results&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The rate of restenosis on control angiography at nine months &#40;27&#37;&#41; in our study is similar to that reported in the literature&#46; In randomized trials of beta radiation for ISR&#44; the mean restenosis rate at 6&#8211;9 months was 30&#37; &#40;26&#37;&#8211;34&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a> A surprising finding was two cases &#40;18&#37;&#41; of occlusive target vessel restenosis&#44; despite dual antiplatelet therapy&#44; in patients who did not suffer acute coronary syndrome&#44; and were in fact asymptomatic&#46; In a review by Waksman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> of 473 patients treated by beta and gamma brachytherapy and who received only one month of dual antiplatelet therapy&#44; late occlusion occurred in 9&#46;1&#37;&#44; and only 7&#37; of these were asymptomatic&#44; while 43&#37; had MI and 50&#37; presented unstable angina&#46; The possibility of late restenosis after brachytherapy for ISR has been demonstrated in studies with longer follow-up &#40;up to five years&#41;&#44; frequently necessitating late TVR&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">In our study&#44; with a mean 10-year follow-up&#44; the incidence of MACE was 16&#46;6&#37;&#46; This figure is low considering the severity of the patients treated and the long follow-up period&#46; In studies with follow-up of up to one year&#44; the mean rate of MACE was 23&#37; &#40;15&#37;&#8211;34&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a> In the only published study with a 10-year follow-up &#40;by the Thoraxcenter&#44; Rotterdam<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#41;&#44; in 124 patients treated by brachytherapy for ISR&#44; death from any cause was 16&#37; and death or non-fatal MI was 25&#37;&#46; The combination of all-cause death&#44; any MI and any revascularization was observed in 70&#37; of these patients&#44; mainly new TVR &#40;47&#37;&#41; between five months and two years of follow-up&#46; Late catch-up following beta brachytherapy was mainly seen in unstented &#40;de novo&#41; lesions&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Despite concerns regarding increased incidence of acute coronary events following brachytherapy&#44; only one patient &#40;8&#46;3&#37;&#41; in this long follow-up suffered acute coronary syndrome&#44; a complication of previous PCI in another vessel&#46; The only cardiac death was late&#44; and occurred almost immediately after complex PCI in a non-target vessel&#46; It can be fairly confidently assumed that these events cannot be attributed to brachytherapy&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In our center&#44; 42&#37; of the patients &#40;n&#61;5&#41; required multiple &#40;n&#61;9&#41; revascularizations of vessels treated by brachytherapy&#46; This is a high proportion compared to the current efficacy of DES&#44; as demonstrated by trials comparing the two approaches&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;28</span></a> However&#44; the complexity of our study population should be borne in mind&#58; 50&#37; with more than one previous restenosis of the treated segment&#44; 67&#37; with multivessel disease&#44; 42&#37; with diabetes and 50&#37; with peripheral arterial disease&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The fact that control angiography was scheduled for nine months may have affected the rate of new TVR observed in our study&#46; The phenomenon of &#8216;oculostenotic reflex&#8217; has been recognized since the Benestent II study&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> Of the five patients who underwent TVR&#44; four had restenosis on angiography but no angina or positive ischemia test and thus the procedure was not ischemia-driven&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The demonstrated efficacy of DES in treating ISR has reduced the use of brachytherapy for this purpose&#46; In a meta-analysis of randomized studies comparing first-generation DES &#40;sirolimus and paclitaxel&#41; with balloon angioplasty or brachytherapy for treatment of ISR&#44; there was a 65&#37; reduction in TVR and 64&#37; reduction in angiographic restenosis with DES compared to balloon angioplasty or brachytherapy&#44; with no difference in the incidence of death or MI&#44; in a follow-up of 9&#8211;12 months&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> In the TAXUS V ISR trial&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> placlitaxel-eluting stents significantly reduced the need for ischemia-driven TVR compared to beta brachytherapy &#40;18&#46;1&#37; vs&#46; 27&#46;5&#37;&#44; p&#61;0&#46;03&#41; in a two-year follow-up&#46; The SISR trial<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> compared sirolimus-eluting stents and beta or gamma brachytherapy&#59; at three years&#44; the incidence of TVR was not significantly lower with DES &#40;20&#46;8&#37; vs&#46; 29&#46;6&#37;&#44; p&#61;0&#46;073&#41;&#46; At the five-year follow-up of the same study&#44; TVR rates remained similar &#40;24&#46;7&#37; with sirolimus-eluting stents vs&#46; 31&#46;2&#37; with brachytherapy&#44; p&#61;0&#46;179&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> A more recent trial by Wiemer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> comparing beta brachytherapy and sirolimus-eluting stents in a three-year follow-up showed that the TVR rate with brachytherapy at six months &#40;10&#46;4&#37;&#41; &#40;vs&#46; 2&#46;3&#37; with stents&#44; p&#61;0&#46;25&#41; increased to 46&#46;7&#37; &#40;vs&#46; 11&#46;6&#37; with stents&#44; p&#60;0&#46;0001&#41; at three years&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">One important point is that of the five patients who underwent TVR&#44; this was by CABG in three&#44; and these patients had no further target vessel-related events in the rest of follow-up&#46; By contrast&#44; the two patients implanted with DES both suffered clinical restenosis&#44; one of whom underwent CABG and the other suffered sudden death following PCI of a non-target vessel&#46; It should however be pointed out that there was no significant occlusive disease in the anterior descending artery in these two patients&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Brachytherapy has recently resurfaced as an option for the treatment of restenosis of DES&#44; but it is rarely used&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">In conclusion&#44; in our limited experience&#44; intracoronary brachytherapy to treat diffuse restenosis of BMS is safe&#44; with acceptable rates of angiographic restenosis at nine months and MACE at 10 years&#44; bearing in mind the characteristics of the population treated&#46; Although the number of TVRs was high&#44; they were required in only five patients&#44; while 41&#37; of patients were event-free at the end of the follow-up period&#44; confirming the long-term safety of the procedure&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Limitations</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors acknowledge the following limitations to the present study&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#40;1&#41;</span><p id="par0190" class="elsevierStylePara elsevierViewall">It was a retrospective&#44; observational study in a single center&#44; with a small patient sample&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#40;2&#41;</span><p id="par0195" class="elsevierStylePara elsevierViewall">There was no control group&#44; the results being interpreted by comparison with those in the literature&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#40;3&#41;</span><p id="par0200" class="elsevierStylePara elsevierViewall">The patients included were a highly selected subgroup of considerable clinical and angiographic complexity followed over the course of 10 years&#44; which should be borne in mind when interpreting the rate of clinical events recorded during follow-up&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#40;4&#41;</span><p id="par0205" class="elsevierStylePara elsevierViewall">Since this was our center&#39;s initial experience with this technique&#44; the results inevitably reflect the learning curve associated with any new procedure&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#40;5&#41;</span><p id="par0210" class="elsevierStylePara elsevierViewall">Procedures performed 10 years ago may not reflect current practice&#44; which will have been influenced by changes in therapeutic strategies&#44; available devices&#44; and the evidence base&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#40;6&#41;</span><p id="par0215" class="elsevierStylePara elsevierViewall">The control angiography scheduled for all patients&#44; irrespective of evidence of ischemia&#44; may have overestimated the need for TVR&#46;</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protection of human and animal subjects</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Confidentiality of data</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Right to privacy and informed consent</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Until the development of drug-eluting stents &#40;DES&#41;&#44; diffuse in-stent restenosis &#40;ISR&#41; was the main limitation of bare-metal stents in percutaneous coronary intervention &#40;PCI&#41;&#46; Among the different treatments available&#44; intracoronary brachytherapy &#40;BT&#41; emerged as one of the most promising&#44; although it was almost abandoned with the increasing use of DES&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">To assess the Portuguese experience with <span class="elsevierStyleSup">90</span>Sr&#47;<span class="elsevierStyleSup">90</span>Y beta brachytherapy for the treatment of diffuse ISR regarding long-term &#40;&#62;10 years&#41; major adverse cardiac events &#40;MACE&#41; and angiographic restenosis&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">This single-center&#44; retrospective&#44; observational study included 12 consecutive patients treated between January and June 2001&#44; mean age 58&#46;6&#177;9&#46;9 years &#40;range 43&#8211;77 years&#41;&#44; 11 male&#46; All had chronic stable angina&#44; 75&#37; had dyslipidemia&#44; 58&#37; had hypertension&#44; 50&#37; had peripheral arterial disease&#44; 42&#37; had diabetes and 50&#37; had multivessel disease&#46; Recurrent ISR was present in half of the patients and 11 had normal left ventricular function&#46; After balloon dilatation&#44; BT was performed using an <span class="elsevierStyleSup">90</span>Sr&#47;<span class="elsevierStyleSup">90</span>Y &#40;Novoste Beta-Cath&#8482;&#41; beta radiation source&#46; All patients remained under dual antiplatelet therapy until scheduled nine-month follow-up angiography&#46; Patients were followed for the occurrence of death &#40;all-cause and cardiovascular&#41;&#44; non-fatal myocardial infarction &#40;MI&#41;&#44; revascularization&#44; stent thrombosis and angiographic restenosis&#46; MACE were defined as the combined incidence of cardiac death&#44; MI and urgent target vessel revascularization&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">In all cases there was both clinical and angiographic success&#46; In a mean follow-up of 10&#46;9&#177;2&#46;5 years&#44; 19 events occurred in seven patients&#58; death in three &#40;25&#37;&#41;&#44; only one cardiac &#40;8&#46;3&#37;&#41;&#59; ST-elevation MI in one &#40;related to a non-target vessel&#41; &#40;8&#46;3&#37;&#41;&#59; and 15 revascularizations in five &#40;42&#37;&#41;&#44; of which nine were of the target vessel &#40;mainly in the first two years&#41;&#46; There was only one case of probable stent thrombosis&#46; Angiographic restenosis at nine months was 27&#37; &#40;three out of 11 patients&#41;&#44; of which two were total occlusions&#46; Ten-year MACE-free survival was 42&#37; &#40;5 patients&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Intracoronary beta brachytherapy for the treatment of diffuse ISR in this small cohort of patients proved to be safe and efficacious&#44; with no late adverse events related to intracoronary radiation&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Introdu&#231;&#227;o</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">No advento dos <span class="elsevierStyleItalic">stents</span> eluidores de f&#225;rmaco &#40;DES&#41;&#44; a reestenose difusa &#40;&#62;20 mm&#41; <span class="elsevierStyleItalic">intrastent</span> &#40;RDIS&#41; constitu&#237;a a principal limita&#231;&#227;o ao uso de <span class="elsevierStyleItalic">stents</span> met&#225;licos na interven&#231;&#227;o coron&#225;ria &#40;PCI&#41;&#46; Das v&#225;rias solu&#231;&#245;es propostas para o seu tratamento&#44; a braquiterapia intracoron&#225;ria &#40;BT&#41; revelou-se uma das mais eficazes&#44; sendo praticamente abandonada ap&#243;s a introdu&#231;&#227;o dos DES&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar os resultados cl&#237;nicos a longo prazo &#40;&#62;10 anos&#41; do uso de BT beta com <span class="elsevierStyleSup">90</span>Sr&#47;Y<span class="elsevierStyleSup">90</span> para o tratamento RDIS&#44; em termos de eventos card&#237;acos <span class="elsevierStyleItalic">major</span> &#40;MACE&#41; e reestenose angiogr&#225;fica&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Popula&#231;&#227;o e m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo retrospetivo observacional de centro &#250;nico incluindo 12 doentes &#40;dts&#41; consecutivos entre janeiro e julho de 2001&#44; 11 homens&#44; com a idade m&#233;dia de 58&#44;6&#177;9&#44;9 anos &#40;43-77 anos&#41;&#46; Todos tinham angor est&#225;vel&#46; Os principais fatores de risco eram dislipidemia &#40;75&#37;&#41;&#44; HTA &#40;58&#37;&#41;&#44; doen&#231;a arterial perif&#233;rica &#40;50&#37;&#41; e diabetes &#40;42&#37;&#41;&#46; Havia doen&#231;a multivaso em seis dts&#44; tratava-se da 2&#46;<span class="elsevierStyleSup">a</span> ou 3&#46;<span class="elsevierStyleSup">a</span> reestenose em seis dts e a fun&#231;&#227;o ventricular era normal em 11&#46; A BT foi feita ap&#243;s dilata&#231;&#227;o com bal&#227;o&#44; usando a fonte emissora de radia&#231;&#227;o beta <span class="elsevierStyleSup">90</span>Sr&#47;Y<span class="elsevierStyleSup">90</span> &#40;Beta-Cath&#8482;&#47;Novoste&#41;&#46; Todos permaneceram sob dupla antiagrega&#231;&#227;o pelo menos at&#233; &#224; angiografia de controlo&#44; programada para todos aos nove meses&#46; Foi considerada a ocorr&#234;ncia de morte global e cardiovascular&#44; enfarte do mioc&#225;rdio n&#227;o fatal &#40;EAM&#41;&#44; revasculariza&#231;&#227;o coron&#225;ria&#44; trombose de <span class="elsevierStyleItalic">stent</span> e reestenose angiogr&#225;fica&#46; Foi avaliada a incid&#234;ncia do evento hier&#225;rquico combinado &#40;MACE&#41; de&#58; morte cardiovascular&#44; EAM&#44; revasculariza&#231;&#227;o coron&#225;ria urgente do vaso alvo &#40;TVRurg&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Verificou-se sucesso angiogr&#225;fico e cl&#237;nico em 100&#37; dos casos&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">No seguimento m&#233;dio de 10&#44;9&#177;2&#44;5 anos&#44; ocorreram 19 eventos em sete dts&#58; morte em tr&#234;s dts &#40;25&#37;&#41;&#44; apenas uma card&#237;aca &#40;8&#44;3&#37;&#41;&#44; EAM com eleva&#231;&#227;o de ST &#40;vaso n&#227;o alvo&#41; num dt &#40;8&#44;3&#37;&#41; e 15 novas revasculariza&#231;&#245;es em cinco dts &#40;42&#37;&#41;&#58; nove relacionadas com o vaso alvo &#40;sobretudo nos primeiros dois anos&#41;&#46; Apenas se verificou uma trombose de <span class="elsevierStyleItalic">stent</span>&#44; prov&#225;vel&#46; A reestenose angiogr&#225;fica aos nove meses de seguimento foi de 27&#37; &#40;3&#47;11 dts&#41; com duas oclus&#245;es&#46; A taxa de sobreviv&#234;ncia livre de MACE aos dez anos foi de 42&#37; &#40;cincodts&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A braquiterapia com radia&#231;&#227;o beta para RDIS&#44; neste pequeno grupo de dts&#44; demonstrou-se eficaz e segura&#44; sem eventos tardios atribu&#237;veis &#224; radia&#231;&#227;o intracoron&#225;ria&#46;</p>"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Seabra Gomes R&#44; de Ara&#250;jo Gon&#231;alves P&#44; Campante Teles R&#44; et al&#46; Avalia&#231;&#227;o tardia &#40;&#62;10 anos&#41; da braquiterapia intracoron&#225;ria com radia&#231;&#227;o beta para reestenose difusa <span class="elsevierStyleItalic">intrastent</span>&#46; Rev Port Cardiol&#46; 2014&#59;33&#58;609&#8211;616&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Survival free of first cardiovascular event &#40;cardiac death&#44; myocardial infarction or target vessel revascularization&#41; &#40;Kaplan-Meier curve&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">ACE&#58; angiotensin-converting enzyme&#59; CABG&#58; coronary artery bypass grafting&#59; LV&#58; left ventricular&#59; MI&#58; myocardial infarction&#59; PAD&#58; peripheral arterial disease&#59; PCI&#58; percutaneous coronary intervention&#46;</p>"
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                  \t\t\t\t">11 &#40;92&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">9 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">7 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PAD&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Smoking&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">4 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CABG&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">12 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Positive ischemia test&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">10 &#40;83&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;67&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Second restenosis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Third restenosis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">12 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Statins&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Beta-blockers&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Calcium channel blockers&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACE inhibitors&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nitrates&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Target vessel n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anterior descending&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Circumflex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Right coronary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Type of stent &#40;total 20&#41;&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ACS MULTI-LINK&#8482; TETRA &#40;Guidant&#47;Advanced Cardiovascular Systems&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bx Velocity&#8482; &#40;Cordis&#44; Johnson &#38; Johnson&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>AVE GFX-2&#8482; &#40;Arterial Vascular Engineering&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>AVE S670&#8482; &#40;Arterial Vascular Engineering&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NIROYAL&#8482; &#40;Medinol&#47;Scimed Life Systems&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bx Velocity&#8482; heparin-coated stent &#40;Cordis&#44; Johnson &#38; Johnson&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Quantitative analysis</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean reference vessel diameter &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;56&#177;0&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean minimal luminal diameter &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;0&#177;0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean degree of stenosis &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;4&#177;16&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean lesion length &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;9&#177;19&#46;5 &#40;40&#8211;90 mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mean follow-up &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;9&#177;2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Patients with events</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MACE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;16&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiac death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urgent TVR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>All-cause death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>TVR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;41&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Any revascularization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;41&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Definite stent thrombosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Probable stent thrombosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Possible stent thrombosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Events related to the vessel treated by brachytherapy &#40;n&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cardiac death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Angiographic restenosis at nine months<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total TVR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Patients with at least one TVR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total TVR by CABG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab580149.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Of the 12 patients treated&#44; only 11 underwent scheduled nine-month control angiography&#46; CABG&#58; coronary artery bypass grafting&#59; MACE&#58; major adverse cardiac events&#59; MI&#58; myocardial infarction&#59; TVR&#58; target vessel revascularization&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Outcomes&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">CABG&#58; coronary artery bypass grafting&#59; DES&#58; drug-eluting stent&#59; FUP&#58; follow-up&#59; ISR&#58; in-stent restenosis at nine months&#59; NTVR&#58; non-target vessel revascularization&#59; Revasc&#58; revascularization at nine months&#59; ST&#58; stent thrombosis&#59; STEMI&#58; ST-segment elevation myocardial infarction&#59; TVR&#58; target vessel revascularization&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patient no&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Clinical status at nine months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">ISR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Revasc&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">EventMonths FUP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">EventMonths FUP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">EventMonths FUP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">EventMonths FUP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">EventMonths FUP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Clinical statusMonths FUP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asymptomatic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Died &#40;cancer&#41;90 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asymptomatic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&#40;occlusion&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TVR&#40;CABG&#41;23 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asymptomatic149 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asymptomatic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NTVR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NTVR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TVR&#40;CABG&#41;21 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NTVR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NTVR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">STEMISTNTVR120 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asymptomatic145 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asymptomatic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&#40;occlusion&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TVR9 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TVR&#40;DES&#41;13 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TVR&#40;DES&#41;19 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TVR&#40;CABG&#41;35 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asymptomatic140 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asymptomatic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TVR9 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TVR&#40;DES&#41;30 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NTVR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MSC43 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sudden cardiac death43 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asymptomatic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Angiography not performed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Died &#40;sepsis&#41;132 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Angina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TVR&#40;CABG&#41;14 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asymptomatic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab580148.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Description of events&#46;</p>"
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      ]
    ]
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      "titulo" => "References"
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        0 => array:2 [
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            0 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Mehran"
                            1 => "G&#46; Dangas"
                            2 => "A&#46;S&#46; Abizaid"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1999"
                        "volumen" => "100"
                        "paginaInicial" => "1872"
                        "paginaFinal" => "1878"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10545431"
                            "web" => "Medline"
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                0 => array:2 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46;A&#46; Mahdi"
                            1 => "A&#46;Z&#46; Pathan"
                            2 => "L&#46; Harrell"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                          "colaboracion" => "Restenosis Intra-stent&#58; Balloon Angioplasty Versus Elective Stenting &#40;RIBS&#41; Investigators"
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                          "autores" => array:3 [
                            0 => "F&#46; Alfonso"
                            1 => "J&#46; Zueco"
                            2 => "A&#46; Cequier"
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                  ]
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;S&#46; Teirstein"
                            1 => "V&#46; Massullo"
                            2 => "S&#46; Jani"
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                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1056/NEJM199706123362402"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Intracoronary gamma-radiation therapy after angioplasty inhibits recurrence in patients with in-stent restenosis"
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                            1 => "R&#46;L&#46; White"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "Revista" => array:6 [
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46;B&#46; Leon"
                            1 => "P&#46;S&#46; Teirstein"
                            2 => "J&#46;W&#46; Moses"
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                        ]
                      ]
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                      "doi" => "10.1056/NEJM200101253440402"
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                          "etal" => true
                          "autores" => array:3 [
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                            2 => "A&#46;J&#46; Lansky"
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                    ]
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                          "etal" => true
                          "autores" => array:3 [
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                            2 => "A&#46;C&#46; Yeung"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2002"
                        "volumen" => "359"
                        "paginaInicial" => "551"
                        "paginaFinal" => "557"
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                          0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for percutaneous coronary interventions&#46; The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology"
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    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack100841"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0240" class="elsevierStylePara elsevierViewall">The authors are grateful to SOCIME Medical&#44; in the person of Dr&#46; Paulo Amaro&#44; for their provision of the material used in beta brachytherapy&#46; They also thank the Francisco Gentil Portuguese Oncology Institute for its assistance in putting together the multidisciplinary team &#40;radiation therapists L&#46; Jorge and M&#46; Rold&#227;o&#44; and medical physicists N&#46; Teixeira and P&#46; Ferreira&#41; and for storing the radioactive source&#44; and Bristol Myers Squibb Farmac&#234;utica Lda&#46; for supplying clopidogrel to all patients up to the nine-month control angiogram&#46; Finally we thank all the physicians&#44; nurses&#44; technicians and secretarial staff of the Cardiology Department of Hospital de Santa Cruz&#44; particularly the Cardiac and Vascular Intervention Unit&#44; for their assistance in the brachytherapy procedures&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
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    "identificador" => "9917"
    "tipo" => "SECCION"
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      "titulo" => "Original Articles"
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  "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003300000010/v1_201411060106/S2174204914002025/v1_201411060106/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204914002025?idApp=UINPBA00004E"
]

Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2014.02.019

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Year/Month	Html	Pdf	Total

2024 November	4	8	12
2024 October	30	43	73
2024 September	40	24	64
2024 August	37	32	69
2024 July	30	32	62
2024 June	26	21	47
2024 May	30	21	51
2024 April	23	20	43
2024 March	26	10	36
2024 February	29	19	48
2024 January	23	30	53
2023 December	12	25	37
2023 November	24	31	55
2023 October	19	13	32
2023 September	22	18	40
2023 August	12	8	20
2023 July	15	10	25
2023 June	19	19	38
2023 May	23	26	49
2023 April	12	9	21
2023 March	26	19	45
2023 February	18	15	33
2023 January	20	20	40
2022 December	32	22	54
2022 November	28	26	54
2022 October	20	24	44
2022 September	23	36	59
2022 August	14	29	43
2022 July	25	45	70
2022 June	14	25	39
2022 May	22	24	46
2022 April	22	31	53
2022 March	20	41	61
2022 February	27	34	61
2022 January	14	28	42
2021 December	14	32	46
2021 November	27	23	50
2021 October	30	42	72
2021 September	21	24	45
2021 August	21	29	50
2021 July	14	27	41
2021 June	15	18	33
2021 May	16	25	41
2021 April	37	50	87
2021 March	42	11	53
2021 February	44	16	60
2021 January	16	14	30
2020 December	39	11	50
2020 November	31	8	39
2020 October	16	13	29
2020 September	52	5	57
2020 August	10	10	20
2020 July	50	2	52
2020 June	16	7	23
2020 May	36	4	40
2020 April	30	6	36
2020 March	32	7	39
2020 February	34	22	56
2020 January	37	4	41
2019 December	25	6	31
2019 November	133	8	141
2019 October	26	6	32
2019 September	23	12	35
2019 August	27	3	30
2019 July	44	6	50
2019 June	43	13	56
2019 May	25	6	31
2019 April	16	11	27
2019 March	39	9	48
2019 February	79	14	93
2019 January	80	4	84
2018 December	33	12	45
2018 November	114	6	120
2018 October	304	22	326
2018 September	98	12	110
2018 August	67	9	76
2018 July	33	6	39
2018 June	26	10	36
2018 May	44	3	47
2018 April	36	6	42
2018 March	32	5	37
2018 February	25	6	31
2018 January	28	2	30
2017 December	54	7	61
2017 November	46	10	56
2017 October	32	12	44
2017 September	39	8	47
2017 August	35	11	46
2017 July	27	19	46
2017 June	52	15	67
2017 May	39	8	47
2017 April	24	11	35
2017 March	30	5	35
2017 February	34	5	39
2017 January	39	0	39
2016 December	34	10	44
2016 November	16	0	16
2016 October	34	6	40
2016 September	18	3	21
2016 August	4	1	5
2016 July	9	5	14
2016 June	10	1	11
2016 May	9	7	16
2016 April	34	2	36
2016 March	40	18	58
2016 February	63	23	86
2016 January	53	21	74
2015 December	56	21	77
2015 November	40	15	55
2015 October	54	17	71
2015 September	41	19	60
2015 August	32	11	43
2015 July	35	4	39
2015 June	13	4	17
2015 May	35	13	48
2015 April	33	11	44
2015 March	24	7	31
2015 February	28	9	37
2015 January	34	21	55
2014 December	63	22	85
2014 November	100	42	142

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