Brachytherapy. Savior or tease.

Dating from the inception of percutaneous coronary angioplasty, restenosis has been the postprocedural Achilles heel. Despite a decade of research, with a myriad of mechanical devices and pharmacologic agents, this vexing problem has yet to be resolved. Although intracoronary stents have proved effective at restenosis reduction, they have yet to achieve an acceptable level and, in some cases, remain resistant to any treatment. Intracoronary radiation using gamma or beta isotopes, has generated tremendous excitement with promising results. Indeed, the SCRIPPS (Scripps Coronary Radiation to Inhibit Proliferation Post Stenting) trial, which employed gamma radiation, showed a statistically significant reduction in restenosis in a small patient population. Further studies with a variety of isotopes and delivery modalities are currently underway, bringing with them their own assemblage of issues.