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(Circulation. 2003;108:389.)
© 2003 American Heart Association, Inc.

Mini-Review: Expert Opinions

Vascular Brachytherapy Boon or Bust?

Dean J. Kereiakes, MD; James T. Willerson, MD

From the Carl and Edyth Lindner Center for Research and Education (D.J.K.), Ohio Heart Health Center, Cincinnati, Ohio, and St Luke’s Episcopal Hospital/Texas Heart Institute (J.T.W.), Houston, Tex.

Correspondence to Dean J. Kereiakes, MD, Carl and Edyth Lindner Center for Research and Education, 2123 Auburn Ave, Suite 424, Cincinnati, OH 45219 (e-mail lindner@fuse.net), or James T. Willerson, MD, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, Room B524 (MC1-267), Houston, TX 77030-2697 (e-mail suzy.lanier@uth.tmc.edu).

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In the present issue of Circulation, Drs Teirstein and King¹ and Waksman and Weinberger² provide a chronology for the evolution in concept and practice of vascular brachytherapy (VBT). The documentation for durable efficacy of VBT in suppressing recurrent in-stent restenosis (ISR) has been provided by multiple randomized controlled clinical trials. The importance of extending the length of radiated arterial segments well beyond the zone of procedural endoluminal injury has become evident. Similarly, the relative clinical and angiographic safety of VBT (versus conventional therapies for ISR) has been demonstrated, and specific procedural as well as adjunctive pharmacological protocol modifications have evolved. These have included the avoidance of restenting and the prolonged administration of clopidogrel therapy, which have collectively effectively eliminated the previously alarming issue of late thrombosis after VBT. Finally, an effective and safe therapy for restenosis, the "Achilles heel" of percutaneous stent deployment, was available. Just as many interventional programs are successfully implementing multidisciplinary VBT programs, the primary indication for VBT (ISR) has been apparently "cured." Drs Teirstein and King¹ pose the question, "Will drug-coated stents transform vascular brachytherapy into a cure without a disease?" Their expert opinion answer to this question is "No." Even in a study patient population composed largely of single-vessel, single-lesion coronary disease, angiographic binary restenosis rates after Cypher drug-eluting stent (DES) deployment were 8.6% overall, 18% in diabetics (35% for insulin-treated diabetics), and16% in small vessels. Higher rates of restenosis (25%) have been reported for more complex patient subsets, such as those with . . . [Full Text of this Article]

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