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Paclitaxel-Eluting Stents, Brachytherapy, and In-Stent Restenosis—Reply
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In Reply: Drs Kaneda and Ako raise questions about late loss in our study. The finding that late loss was approximately 0.16 mm less with VBT compared with paclitaxel-eluting stent implantation in the injury zone reflects in part the much greater acute gain (approximately 0.55 mm more) with the drug-eluting stent, which by itself induces more late loss,1 as well as the significantly longer length of the drug-eluting stent injury zone.
However, injury zone measurements do not take into account radiation-associated edge effects, which can profoundly increase target lesion late loss.2 In the much longer analysis segment (which includes the margins of each therapy), a nonstatistically significant difference in late loss was shown comparing drug-eluting stents and VBT (median, 0.13 vs 0.22 mm, respectively; P = .08), despite the markedly greater analysis segment acute gain. Thus, the combination of greater acute gain and less late loss results in the significantly larger . . . [Full Text of this Article]
Gregg W. Stone, MD
gs2184@columbia.edu
Columbia University Medical Center
New York, NY
Jeffrey J. Popma, MD
Brigham and Women's Hospital
Boston, Mass
Stephen G. Ellis, MD
Cleveland Clinic Foundation
Cleveland, Ohio
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