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To the Editor: Dr Stone and colleagues¹ compared paclitaxel-eluting stents with vascular brachytherapy (VBT) for in-stent stenosis within bare-metal stents. In the "Comment" section, the authors stated, "Because of both greater acute gain and less late loss, luminal dimensions were significantly larger with paclitaxel-eluting stents compared with VBT in the injury zone, at the distal edge, and over the entire analysis segment."

However, Table 4 shows significantly greater late loss with paclitaxel-eluting stents (median, 0.27 mm) compared with VBT (median, 0.11 mm; P<.001) in the injury segment. Smaller lumen diameter and higher restenosis were mainly due to less acute gain, suggesting suboptimal initial mechanical treatment (angioplasty) before radiation therapy. If sufficient acute gain could be achieved before radiation therapy, VBT might be still an option for in-stent restenosis.

Financial Disclosures: None reported.

Hideaki Kaneda, MD, PhD
kaneda@kamakuraheart.org
Shonan Kamakura General Hospital
Kamakura, Japan

Junya Ako, MD
Stanford University
Stanford, Calif

1. Stone GW, Ellis SG, O'Shaughnessy CD, et al, TAXUS V ISR Investigators. Paclitaxel-eluting stents vs vascular brachytherapy for in-stent restenosis within bare-metal stents: the TAXUS V ISR randomized trial. JAMA. 2006;295:1253-1263. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;296:1838.

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