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Sirolimus-Eluting Stents vs Brachytherapy for Restenosis
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To the Editor: Dr Holmes and colleagues1 reported the results of the Sirolimus-Eluting Stent vs Brachytherapy in Patients With Bare Metal In-Stent Restenosis (SISR) trial, in which they demonstrated that sirolimus-eluting stents are superior to brachytherapy in patients with in-stent restenosis. Rather than merely abandoning brachytherapy because of logistical difficulties, it would be helpful if the authors provided additional information.
First, because the irradiated segment (39.7 mm) was longer than the segment covered by sirolimus-eluting stents (32.4 mm), the "analysis segment" was biased in a way that would penalize the brachytherapy group. Adjusting the results for the difference in the analysis segment lengths in the 2 groups would be important.
Second, the geographic miss phenomenon after brachytherapy may be clinically important.2 The unexpectedly high number of edge restenoses in the brachytherapy group raises a question of whether the efforts made by the investigators to prevent this phenomenon were insufficient. This . . . [Full Text of this Article]
Fernando Alfonso, MD
falf@hotmail.com
San Carlos University Hospital
Madrid
Manel Sabate, MD
Sant Pau Hospital
Barcelona, Spain
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