ABSTRACT
Introduction Following introduction into clinical practice, the long-term success of percutaneous coronary intervention (PCI) has been most limited by restenosis of the target-vessel segment. Initially, restenosis rates following percutaneous coronary angioplasty (PTCA) exceeded 50% (1,2), and attempts to reduce the frequency of restenosis and possible repeat revascularization included the use of bare-metal stents (BMS). Long-term studies using BMS revealed improved, yet still significant, rates of restenosis (~17%–20%) (3-5). Therefore, in the late 1990s, newer therapies including intracoronary brachytherapy (ICB) were developed in attempts to treat in-stent restenosis (ISR). Initial studies using ICB were promising, but limited by predictable complications such as edge restenosis and late thrombosis. More recently, the introduction of drug-eluting stents (DES) into the practice of interventional cardiology has nearly eliminated the use of ICB. This chapter attempts to summarize the theoretical basis, clinical trials, limitations, and possible therapeutic role of ICB in the drug-eluting stent era.
