Favorable effect of γ-radiation for in-stent restenosis: Effect of diabetes on angiographic and clinical outcomes

The purpose of this study was to examine the effect of vascular brachytherapy with γ-radiation (γ-RT) in patients with diabetes mellitus (DM) with coronary in-stent restenosis (ISR). In the Washington Radiation for In-Stent Restenosis (WRIST) trial, 130 patients with ISR were treated with ¹⁹²Ir or placebo. Of the patients enrolled, 44 (34%) had DM (18 of them treated with γ-RT and 26 with placebo). γ-radiation therapy of ISR in diabetics resulted in similar procedural success and in-hospital outcome compared to nondiabetics. At 6-month follow-up, both DM and non-DM patients treated with γ-RT had significantly lower target lesion revascularization (TLR), target vessel revascularization, and major adverse cardiac event rates compared to placebo. DM remains a powerful predictor of TLR and major adverse cardiac events even after treatment of ISR with γ-RT.