Brachytherapy for restenosis after stenting for coronary artery disease: its role in the drug-eluting stent era.
OBJECTIVE
Recent years have brought remarkable changes to the field of interventional cardiology. The need for repeat intervention due to restenosis, the most vexing long-term failure of percutaneous coronary intervention, has been significantly reduced owing to the introduction of two major advances, the vascular brachytherapy (VBT) and the drug-eluting stents (DES).


RESULTS
Vascular brachytherapy has demonstrated its efficacy in limiting recurrence of existing in-stent restenosis. The past 2 years have sealed its reputation, with a variety of studies demonstrating its superiority over conventional therapy in challenging patient subsets with high risk for restenosis recurrence. Moreover, the long-term follow-up confirmed durability of this therapy, and the failures of VBT were characterized as easy to treat. Conversely, DES have shown spectacular efficacy at primarily preventing the first restenosis episode following the initial stent placement. Consequently, the role of VBT may be minimized, as the overall need for repeat revascularization is diminished as a result of the wide acceptance of DES. Furthermore, if the capacity of DES to treat in-stent restenosis is confirmed in randomized trials, they may eventually supersede VBT as the therapy of choice for in-stent restenosis.


CONCLUSIONS
At present, VBT is the proven and durable therapeutic choice for patients with complex, diffuse in-stent restenosis who would otherwise have a very poor prognosis for long-term event-free survival. DES have emerged as remarkably effective in minimizing the first restenosis occurrence; they also represent a promising and competitive alternative to VBT for the treatment of in-stent restenosis.
Kaluza
Grzegorz L
GL
The Methodist DeBakey Heart Center, Houston, Texas 77030, USA.
Raizner
Albert E
AE
D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000592:standards; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000517:prevention & control*; D006801:Humans; D012008:Recurrence; D015607:Stents; D013927:Thrombosis / Q000209:etiology