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Kyaw H, Johal G, Gedela M, Barman N, Kini A, Sharma SK. Is Coronary Brachytherapy Staging a Comeback for the Treatment of In-Stent Restenosis? Curr Cardiol Rep 2021; 23:156. [PMID: 34599432 DOI: 10.1007/s11886-021-01582-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 11/24/2022]
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. 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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Affiliation(s)
- Htoo Kyaw
- 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
| | - Gurpreet Johal
- 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
| | - Maheedhar Gedela
- 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
| | - Nitin Barman
- 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
| | - Annapoorna Kini
- 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
| | - Samin K Sharma
- 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.
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Bae JW, Koo BK, Kim KI, Kang HJ, Cho YS, Youn TJ, Chung WY, Chae IH, Kim HS, Lee MM, Oh BH, Park YB. Two-year outcomes of repeated brachytherapy in patients with restenosis after intracoronary radiation therapy. Am J Cardiol 2004; 94:1061-3. [PMID: 15476627 DOI: 10.1016/j.amjcard.2004.06.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Revised: 06/30/2004] [Accepted: 06/30/2004] [Indexed: 10/26/2022]
Abstract
This study compared the 2-year outcomes of repeat brachytherapy (n = 10) and conventional percutaneous intervention (n = 14) in patients with restenosis after intracoronary brachytherapy with a rhenium-188-filled balloon system. The short-term target lesion revascularization rate was significantly lower in the repeat brachytherapy group (0% vs 36%, p = 0.038), and additional target lesion revascularization was required in 2 patients with repeat brachytherapy during 2-year follow-up. There were no vascular complications related to repeat brachytherapy.
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Affiliation(s)
- Jang-Whan Bae
- Cardiovascular Center, Seoul National University Hospital, Korea
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