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Is Coronary Brachytherapy Staging a Comeback for the Treatment of In-Stent Restenosis?

  • New Therapies for Cardiovascular Disease (AA Bavry and MR Massoomi, Section Editors)
  • Published:
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Abstract

Purpose of Review

The catheter-based coronary intervention has become a well-established therapeutic modality for obstructive coronary artery disease. However, in-stent restenosis remains a significant limitation of coronary intervention despite the use of newer devices. Intravascular brachytherapy was introduced to treat recurrent in-stent restenosis but only modestly adopted. This review will discuss the mechanism of intracoronary brachytherapy, available clinical evidence of brachytherapy in recurrent in-stent restenosis treatment, and the future of coronary brachytherapy in coronary intervention.

Recent Findings

Drug-eluting stents have an inherent limitation as they leave a permanent metal layer inside an artery when deployed. Recently, drug-coated balloon technology has emerged to treat coronary artery disease as a combination of balloon angioplasty and local drug delivery without leaving a metal layer behind. Recent European guidelines recommended using drug-coated balloons when treating in-stent restenosis treatment, while the US guidelines have not yet addressed the use of drug-coated balloons in such cases.

Summary

Coronary brachytherapy is a valuable addition to treat these challenging diseases despite several logistic issues. If there are newer technologies with easier setup, such as drug-coated balloons, coronary brachytherapy resurgence is improbable in the contemporary era, although it may not become obsolete.

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  1. Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA

    Htoo Kyaw, Gurpreet Johal, Maheedhar Gedela, Nitin Barman, Annapoorna Kini & Samin K. Sharma

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Kyaw, H., Johal, G., Gedela, M. et al. Is Coronary Brachytherapy Staging a Comeback for the Treatment of In-Stent Restenosis?. Curr Cardiol Rep 23, 156 (2021). https://doi.org/10.1007/s11886-021-01582-4

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