Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN.
Vanderbilt University School of Medicine, Nashville, TN.
Brachytherapy. 2021 Mar-Apr;20(2):485-493. doi: 10.1016/j.brachy.2020.09.012. Epub 2020 Oct 29.
Despite the advent of drug-eluting stents and dual antiplatelet therapy in the interventional management of cardiovascular disease, restenosis rates remain high with significant sequelae. Endovascular brachytherapy-popular in the 1990s and early 2000s-has recently resurfaced as a cost-effective treatment option. In this work, we outline the history of endovascular brachytherapy starting with its earliest promise in the 1990s. We discuss the development of drug-eluting stents and dual antiplatelet strategies and their impact on the perceived benefit of endovascular brachytherapy. For the contemporary era, we propose novel roles for endovascular brachytherapy in complex coronary artery disease and in high-risk patients managed with drug-eluting stents. We discuss the impetus for reducing the requirement and duration of dual antiplatelet therapy using endovascular brachytherapy. We also review innovative opportunities for endovascular brachytherapy after bare-metal stent placement in both coronary and noncoronary territories and offer economic arguments in favor of endovascular brachytherapy. Trials of endovascular brachytherapy in these regimes are merited.
尽管药物洗脱支架和双联抗血小板治疗在心血管疾病的介入治疗中已经出现，但再狭窄率仍然很高，且存在严重的后遗症。血管内放射治疗——在 20 世纪 90 年代和 21 世纪初很流行——最近又重新成为一种具有成本效益的治疗选择。在这项工作中，我们从 20 世纪 90 年代最早的承诺开始，概述了血管内放射治疗的历史。我们讨论了药物洗脱支架和双联抗血小板策略的发展，以及它们对血管内放射治疗的预期益处的影响。对于当代，我们提出了血管内放射治疗在复杂冠状动脉疾病和使用药物洗脱支架治疗的高危患者中的新作用。我们讨论了使用血管内放射治疗减少双联抗血小板治疗的需求和持续时间的动力。我们还回顾了在冠状动脉和非冠状动脉区域放置裸金属支架后血管内放射治疗的创新机会，并提供了支持血管内放射治疗的经济论据。在这些治疗方案中进行血管内放射治疗的试验是有价值的。
