Geographical miss has been associated with treatment failures after intracoronary radiation therapy. This phenomenon, which is secondary to vascular injury outside the treated segment, was strongly correlated with the development of restenosis at the edges of the treated coronary segment. The European and Canadian SIRIUS trials (E and C-SIRIUS) randomized 350 patients with similar baseline characteristics of the US SIRIUS study. Operators used shorter post-dilatation balloons and direct stented 27% of the patients, achieving a 4.0% TLR rate and a 5.1% in-lesion binary restenosis. These somewhat superior results support the concept that refinement in deployment techniques may further improve clinical outcomes of drug-eluting stents.

Inclusion criteria:

• Diagnosis of de novo stenosis in major coronary artery
• Can be treated with stents
• Candidate for bypass

Exclusion criteria:

• Recent, severe MI
• Prior brachytherapy
• Impaired left ventricle function
• Heart transplant recipient
• Impaired renal function
• Disease in vein grafts from previous bypass
• Similar treatment within the last 30 days