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

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

Research output: Contribution to journalReview articlepeer-review

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.

Original languageEnglish
Article number156
JournalCurrent Cardiology Reports
Volume23
Issue number11
DOIs
StatePublished - Nov 2021
Externally publishedYes

Keywords

  • Coronary artery disease
  • Coronary intervention
  • In-stent restenosis
  • Intravascular coronary brachytherapy

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