Endovascular brachytherapy for prevention of recurrent renal in-stent restenosis

Purpose: To examine the ability of endovascular brachytherapy to prevent recurrent in-stent restenosis in patients at high risk for this complication. Methods: Thirteen renal stent patients (8 women; mean age 66 +/- 8 years) with an initial (n=9) or recurrent (n=4) in-stent restenosis underwent redilation followed by high-doserate brachytherapy (12 Gy of gamma radiation delivered to the target site 5 mm from an iridium-192 source axis). Results: The procedure was technically successful in 11 (85%) patients; in the other 2, the renal artery could not be accessed with the large sheaths required for brachytherapy. One patient with no clinical suspicion of restenosis died of an unrelated cause during the 1-year follow-up. Eight (80%) of 10 patients alive at 1 year had no in-stent restenosis apparent on duplex sonography or angiography. One of the postradiation recurrent restenoses was redilated, but the other patient was treated conservatively. Conclusions: Renal angioplasty followed by brachytherapy seems to be a feasible and efficient method to prevent recurrent in-stent restenosis in renal arteries at increased risk.