After treatment of coronary artery disease with balloon angioplasty and stenting, some patients develop re-narrowing at the treatment site due to excess scar tissue formation. This re-narrowing process is called "restenosis" and may cause recurrence of symptoms such as chest pain or shortness of breath. Fortunately the introduction of drug-coated stents in 2003 greatly reduced the chance of a patient developing restenosis.
The treatment of coronary restenosis varies depending on the amount of scar tissue inside the original stent. When the scar tissue is confined to one area balloon angioplasty alone may be sufficient to open up the narrowing. Sometimes a new drug-coated stent is placed inside the old stent.
When the scar tissue develops over a long length of the artery, or occurs in a patient with two or more layers of stent, radiation treatment is perhaps the best option for preventing the scar tissue from growing back and narrowing the artery again. The radiation treatment procedure is called coronary brachytherapy.
How does radiation therapy affect restenosis?
In much the same way that radiation kills cancer cells, brachytherapy kills the cells in the wall of the artery that cause the scar tissue to form inside the stent.
How is coronary brachytherapy given?
Brachytherapy is performed as part of the usual angioplasty procedure. First, the interventional cardiologist opens the scar tissue with a balloon (angioplasty). Next a thin radioactive ribbon is advanced inside the coronary artery to deliver radiation to the vessel wall. After three to four minutes, the radioactive ribbon is withdrawn and the procedure is completed. The radiation passes only into the wall of the artery and does not affect the rest of the body.
How effective is coronary brachytherapy?
Brachytherapy greatly reduces the chance of recurrent scar tissue formation inside the stent(s) and need for repeat heart catheterization procedures.
Is coronary brachytherapy right for you?
The decision whether to perform coronary brachytherapy will be made by your primary cardiologist and must be customized to each patient. For those patients with multiple episodes of restenosis we believe this is an excellent treatment option, especially if the patient is not a good candidate for coronary artery bypass surgery.