Coronary Brachytherapy

Overview

What is coronary brachytherapy?

Coronary brachytherapy is a treatment for severe coronary artery disease (CAD). CAD develops when plaque builds up in the arteries that supply blood to your heart. Brachytherapy uses radiation to prevent scar tissue growth and keep your arteries open.

Other names for coronary brachytherapy are vascular brachytherapy (VBT), cardiac brachytherapy and adjunctive intracoronary radiation therapy.

Who needs coronary brachytherapy?

Coronary brachytherapy is typically for people with CAD who have already had treatment with percutaneous coronary intervention (PCI). PCI uses a small balloon and a stent (metal mesh tube) to open a blocked artery.

Sometimes scar tissue forms around the stent, causing the artery to narrow again. This condition is called in-stent restenosis (ISR). People with ISR may benefit from coronary brachytherapy.

You may be a candidate for brachytherapy if you have:

  • Health conditions like diabetes that increase your risk of complications during other CAD treatments.
  • Multiple stents or a long stent.
  • Recurring ISR.
  • Small blood vessels.

Who shouldn’t have coronary brachytherapy?

Coronary brachytherapy is only recommended for certain patients. You may not be a candidate if you’ve had:

  • Only one instance of restenosis.
  • Previous radiation therapy to treat breast cancer or cancer in your chest.
  • Restenosis due to a problem with the balloon from your angioplasty, not scar tissue buildup.

Is coronary brachytherapy the only treatment for restenosis?

There are other more common treatments for restenosis, including:

How common is coronary brachytherapy?

Coronary brachytherapy isn’t that common anymore. Newer stents that contain a slow-release drug (drug-eluting stents) have decreased the rate of restenosis to between 5% and 15%. As a result, not as many people need the treatment.

Procedure Details

Who performs coronary brachytherapy?

An interventional cardiologist and a radiation oncologist work together to perform coronary brachytherapy.

What happens before coronary brachytherapy?

Your healthcare provider may order an imaging scan called an intravascular ultrasound to plan your surgery. The ultrasound creates detailed pictures of your coronary arteries. Your provider can see the exact area that needs treatment.

What happens during coronary brachytherapy?

Coronary brachytherapy is a minimally invasive procedure. Your provider uses a catheter (thin, flexible tube) to access the narrowed coronary artery and deliver the local radiation. The procedure only takes about 10 minutes, but you stay at the hospital for several hours.

During the procedure, you can expect:

  1. Sedation: Most people are sedated during catheterization procedures, so you don’t feel any pain but aren’t fully unconscious. Some people receive general anesthesia.
  2. Incision: Your provider inserts a catheter into a blood vessel and uses X-ray guidance to thread it up to your narrowed coronary artery.
  3. Balloon angioplasty: A tiny balloon is inflated in the narrowed artery to widen it for the procedure.
  4. Radiation: Your provider delivers a carefully controlled dose of radiation to the narrowed area of your artery. The radiation stays in place for a few minutes as it destroys the cells that cause scar tissue buildup in an area.
  5. Closure: Your provider removes the radiation and catheter.

What happens after coronary brachytherapy?

Most people go home the day of the procedure, but some stay overnight in the hospital. You’ll rest and avoid strenuous activities for a few days. Your provider will prescribe medicine to prevent blood clots.

Risks / Benefits

What are the benefits of coronary brachytherapy?

Coronary brachytherapy can help treat restenosis in people with severe CAD. It’s a treatment option for people with multiple stents, recurring restenosis or high-risk health conditions.

Brachytherapy can help prevent a heart attack, heart failure or the recurrence of common CAD symptoms such as:

What are the risks of coronary brachytherapy?

The risks of coronary brachytherapy are the same as any other cardiac catheterization procedure:

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

Is the radiation used in brachytherapy safe?

The radiation used in brachytherapy is safe. It’s a very carefully controlled dose and it doesn’t travel to any other areas of your body or damage other tissues.

Recovery and Outlook

What is recovery like after coronary brachytherapy?

Most people can return to normal activities a few days after the procedure. Talk to your doctor about the specific risks and precautions you should take as you recuperate.

What is the outlook for people who have coronary brachytherapy?

Studies suggest that coronary brachytherapy offers good long-term outcomes for people with complex restenosis, but restenosis can develop again. After treatment, people should continue to follow a heart-healthy lifestyle that includes:

  • A low-fat diet.
  • Alcohol consumption in moderation.
  • Not smoking.
  • Regular exercise.

When to Call the Doctor

When should I call the doctor?

You should call your healthcare provider if you experience:

  • Fever.
  • Severe pain in your chest, jaw, arms or shoulders.
  • Shortness of breath.
  • Signs of infection in the incision site, such as pus or foul-smelling drainage.

A note from Cleveland Clinic

Coronary brachytherapy is a treatment for in-stent restenosis (ISR). ISR occurs when scar tissue forms around a stent and causes the artery to get narrow again. Coronary brachytherapy uses radiation to destroy scar tissue and stop it from growing. The treatment isn’t very common, but it may help people with multiple stents, recurring restenosis or chronic health conditions that make them poor candidates for other types of treatment.

Last reviewed by a Cleveland Clinic medical professional on 05/09/2022.

References

  • Dangas G, Kuepper F. Restenosis: Repeat Narrowing of a Coronary Artery. (https://www.ahajournals.org/doi/10.1161/01.cir.0000019122.00032.df) Circulation. 2002 June;105(22):2586-2587. Accessed 5/9/2022.
  • Ohri N, Sharma S, Kini A, et al. Intracoronary brachytherapy for in-stent restenosis of drug-eluting stents. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506705/) Adv Radiat Onc. 2016 Jan-Mar;1(1):4-9. Accessed 5/9/2022.
  • Omeh DJ, Shlofmitz E. Restenosis. (https://www.ncbi.nlm.nih.gov/books/NBK545139/) [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 5/9/2022.

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