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Placing stents in arteries during angioplasty is very effective at keeping heart blood vessels open. But, even when stents are implanted, arteries narrow again in 15%-25% of people. This re-narrowing is called in-stent restenosis. Most restenosis is due to scar tissue that forms in response to the injury created when the stent was implanted. Some scar tissue is useful; it covers the metal stent and helps prevent blood clots from forming. But, in some people, the process does not stop, and the scar tissue re-closes the artery. When restenosis occurs, doctors can fix the problem by radiating the site of re-narrowing. This is called brachytherapy.
What Happens During Brachytherapy?
First angioplasty is performed, and a "ribbon" of radioactive isotopes is placed through the catheter to the site of blockage. The ribbon stays in place for about 4 to 15 minutes, and the catheter is removed.
Are There Risks Associated With Brachytherapy?
Yes. In some cases, blood clots (thrombosis) may occur at the site of radiation months after the procedure is performed. Antiplatelet medications are given after the procedure to decrease the risk of late blood clot formation.
Because brachytherapy is a new treatment, the long-term effects are still unknown. Studies are still underway to evaluate its effects. Two forms of brachytherapy - gamma radiation and beta radiation - were approved by the FDA in 2002.
Who Should Get Brachytherapy?
Brachytherapy is not appropriate for everyone. Those who seem to benefit most from this type of therapy for in-stent restenosis include people at higher risk for re-stenosis, for example, those with diabetes or long stenotic areas (long areas of narrowing).
Since blood clot formation is a side effect of brachytherapy for restenosis, people who have had recent heart attacks, poor heart function and blood clots may not be eligible for this treatment.
Should I Have Brachytherapy?
If you are at high risk for in-stent restenosis, with careful monitoring, brachytherapy may be a treatment option for you. It is best to discuss this with your doctor and an interventional cardiologist with experience in radiation therapy to see if brachytherapy is right for you.
Reviewed by the doctors at The Cleveland Clinic Heart Center.
Edited by Charlotte E. Grayson, MD, June 2004, WebMD.
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