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Sirolimus-Eluting Stents vs Brachytherapy for Restenosis—Reply
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In Reply: Drs Alfonso and Sabate identify that the irradiated segment was longer than the segment covered by sirolimus-eluting stents in the SISR trial. This discrepancy in length was in part related to the specific concern raised about geographic miss. The operators in the trial attempted to minimize this problem by fully covering the margins with radiation. The standard recommended vascular brachytherapy practice during this time was to extend the radiation treatment to 5 mm beyond the injured margins.
Statistical adjustment based on differences in lesion length is commonly performed in angiographic studies. However, because lesion lengths (as opposed to the treatment lengths) were identical in both study groups, no adjustment is warranted. The outcomes of the 2 different treatment strategies resulted in rates of clinically driven target lesion revascularization and target vessel failure that were statistically significant in favor of the use of the sirolimus-eluting stent for treatment of . . . [Full Text of this Article]
David R. Holmes, Jr, MD
holmes.david@mayo.edu
Division of Cardiovascular Diseases
Mayo Clinic
Rochester, Minn
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