Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA.
Curr Cardiol Rep. 2021 Oct 1;23(11):156. doi: 10.1007/s11886-021-01582-4.
The catheter-based coronary intervention has become a well-established therapeutic modality for obstructive coronary artery disease. However, in-stent restenosis remains a significant limitation of coronary intervention despite the use of newer devices. Intravascular brachytherapy was introduced to treat recurrent in-stent restenosis but only modestly adopted. This review will discuss the mechanism of intracoronary brachytherapy, available clinical evidence of brachytherapy in recurrent in-stent restenosis treatment, and the future of coronary brachytherapy in coronary intervention.
Drug-eluting stents have an inherent limitation as they leave a permanent metal layer inside an artery when deployed. Recently, drug-coated balloon technology has emerged to treat coronary artery disease as a combination of balloon angioplasty and local drug delivery without leaving a metal layer behind. Recent European guidelines recommended using drug-coated balloons when treating in-stent restenosis treatment, while the US guidelines have not yet addressed the use of drug-coated balloons in such cases. Coronary brachytherapy is a valuable addition to treat these challenging diseases despite several logistic issues. If there are newer technologies with easier setup, such as drug-coated balloons, coronary brachytherapy resurgence is improbable in the contemporary era, although it may not become obsolete.
经导管冠状动脉介入治疗已成为治疗阻塞性冠状动脉疾病的一种成熟的治疗方法。然而，尽管使用了更新的设备，支架内再狭窄仍然是冠状动脉介入治疗的一个重大限制。血管内放射治疗被引入以治疗复发性支架内再狭窄，但应用并不广泛。本文将讨论冠状动脉内放射治疗的机制、放射治疗治疗复发性支架内再狭窄的临床证据，以及冠状动脉内放射治疗在冠状动脉介入治疗中的未来。
药物洗脱支架有其内在的局限性，因为它们在部署时会在动脉内留下一层永久性的金属。最近，药物涂层球囊技术的出现为治疗冠状动脉疾病提供了一种结合球囊血管成形术和局部药物输送的方法，而不会留下金属层。最近的欧洲指南建议在治疗支架内再狭窄时使用药物涂层球囊，而美国指南尚未涉及在这种情况下使用药物涂层球囊。尽管存在一些后勤问题，但冠状动脉内放射治疗是治疗这些挑战性疾病的一种有价值的方法。如果有更新的技术，如药物涂层球囊，具有更简单的设置，那么在当代，冠状动脉内放射治疗的复兴是不可能的，尽管它可能不会过时。
