The concept of coronary brachytherapy dates back to the 1990s, when restenosis of bare metal stents occurred.
Coronary brachytherapy, which is the delivery of ionizing radiation to the coronary artery, provided more durable results than other percutaneous revascularization techniques at that time.
In more recent years, this has been supplanted by drug-eluting stents. Second-generation drug-eluting stents perform extremely well and have a restenosis rate of less than 5 percent.
Despite our best efforts in the cardiac catheterization lab, there is still an unmet need in a subset of our population who develop restenosis of these newer stents. Additionally, there is some debate about the best therapy for these patients. The current consensus opinion suggests that repeat drug-eluting stenting is the most beneficial. Other institutions perform repeated balloon angioplasty within these stents, noting that increasing layers of stent in the coronary artery “shrinks the room” available for blood flow. At Augusta University Heart and Cardiovascular services, like most other programs around the country, we have patients who continue to present with in-stent restenosis, despite multiple drug-eluting stents and angioplasties, and, thus, another, more durable solution is needed. Coronary brachytherapy provides us with that possible solution.
To this end, we have restarted the coronary brachytherapy program at Augusta University in order to better serve our patients and community. We are currently the only center in Georgia and one of two centers in the entire Southeast with coronary brachytherapy available. Part of the reluctance of many centers to do this is the labor-intensive nature of the procedure and the multiple specialties involved. Our first session was in June 2015, in which we performed coronary brachytherapy successfully on four of our most refractory patients.
Coronary brachytherapy can potentially help these patients to obtain a more durable and long-lasting outcome, resulting in an improved quality of life. A collaborative, multidisciplinary effort at Augusta University, involving interventional cardiologists, radiation oncologists, radiation safety and medical physicists, has resulted in the ability to successfully perform this procedure, to the benefit of our patients and the state of Georgia.
A patient presented with symptomatic coronary artery occlusion with a drug-eluting stent in stent restenosis.