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A case of refractory in‐stent restenosis: Failed RE‐WRIST

Intracoronary radiation (IRT) is the principal established therapy for in-stent restenosis [1–4]. Approximately one-quarter of the patients enrolled in radiation studies for in-stent restenosis require repeat revascularization to the irradiated site. Re-WRIST (Washington Radiation for In-Stent Restenosis Trial) is an FDA-approved 30-patient registry evaluating the safety and efficacy of retreatment with IRT in patients with refractory in-stent restenosis (12 months of clopidogrel and aspirin therapy). To be eligible for this protocol, patients have to fail an additional angioplasty after the index radiation procedure and not be considered surgical candidates. This case report describes one such patient who received a second radiation treatment to the same target lesion and subsequently failed.