Coronary Brachytherapy

Coronary brachytherapy is a radiation treatment of severe coronary artery disease (CAD) that helps prevent or remove scar tissue growth that can build up around stents (in-stent restenosis). 

It is also known as:

• Vascular brachytherapy
• Cardiac brachytherapy 
• Adjunctive intracoronary radiation therapy

Coronary brachytherapy helps prevent a heart attack, heart failure, or the recurrence of CAD symptoms, such as:

• Angina (chest pain)
• Tachycardia (fast heart rate)
• Light-headedness
• Nausea
• Dyspnea (shortness of breath)

Coronary brachytherapy is used as a treatment for people with coronary artery diseases who have undergone percutaneous coronary intervention, a procedure that involves inserting a small balloon and stent (metal mesh tube) to open a blocked artery.

Coronary brachytherapy is indicated if you have:

• Health conditions, such as diabetes (this increases the risk of complications during other treatments for coronary artery disease)
• Multiple stents or a long stent
• Recurring in-stent restenosis 
• Small blood vessels

Coronary brachytherapy is contraindicated if you have:

• Only one instance of restenosis
• History of radiation therapy to treat breast cancer or cancer in the chest 
• Restenosis (due to a problem with the balloon from a previous angioplasty)

Similar to any other cardiac catheterization procedure, the risks involved in coronary brachytherapy include:

• Arrhythmia (abnormal heart rhythm)
• Blood clots
• Blood vessel damage
• Infection
• Pain/discomfort/bleeding at the incision site

Though the procedure only takes around 10 minutes, you might be asked to stay at the hospital for several hours.

The following are the steps of coronary brachytherapy:

• Most people are sedated during catheterization procedures, but some people may receive general anesthesia.
• The cardiologist inserts a catheter (a thin, flexible tube) into the narrowed coronary artery under X-ray guidance.
• A tiny balloon is inflated in the narrowed artery to widen it for the delivery of radiation.
• A controlled dose of local radiation is delivered for about 4 to 15 minutes to the narrowed area of the artery through a ribbon of radioactive isotopes.
• This radiation destroys the cells that cause scar tissue accumulation in that area.
• The cardiologist removes the radiation and catheter.
• Most people are allowed to go home on the day of the procedure.
• Adequate rest and avoiding strenuous activities for a few days are recommended.
• Some medications might be prescribed to prevent blood clots.

After the treatment, you are advised to follow a heart-healthy lifestyle, which includes:

• Consuming a low-fat diet
• Limiting alcohol consumption 
• Avoiding smoking
• Staying active 
• Exercising regularly

Other common treatment alternatives for restenosis include:

• Placement of another drug-coated stent
• Balloon angioplasty/cutting balloon angioplasty 
• Coronary artery bypass surgery
• Medications
  • Aspirin therapy
  • Statins (cholesterol-lowering drugs)