What is Coronary Brachytherapy?
Coronary brachytherapy is a procedure to prevent the blockage of the blood vessel after stent placement. This procedure is beneficial in preventing further blockage but has a few associated risks. It is used in people with severe coronary artery disease. In the Coronary brachytherapy procedure, radiations are used for the removal of scar tissue that can build up around the stent causing the arteries to narrow. Coronary brachytherapy is also known as vascular brachytherapy, cardiac brachytherapy, and adjunctive brachytherapy.
Coronary artery disease is a condition in which the deposition of cholesterol and minerals leads to the blockage of the blood vessels. Over time the blockage makes it difficult for the blood to flow to the vital organs. Sometimes the pieces of plaque break and lead to complications like heart attack and stroke.
Coronary artery disease is commonly treated by placing a stent, a small device that can be helpful in keeping the blood vessel open. These stents are coated with medications that can be helpful in keeping the new plaques from forming. Sometimes the blood vessels treated with stents are affected by repeated narrowing also known as restenosis. It is known to occur in 20-50% of people with coronary artery disease treated with stents(1).
There are two ways in which restenosis can be treated:
- Placing another drug-coated stent
- With the help of radiation therapy
Brachytherapy is a technique in which internal radiations are used for the treatment of various conditions, including cancer. The radiations help in destroying tumors and growths.
Coronary Brachytherapy Procedure
Coronary brachytherapy is a minimally invasive procedure in which a catheter is used to access the narrowed coronary artery and deliver radiation. The procedure in all takes about 10 minutes, but the patient needs to stay in the hospital for several hours.
Before the Coronary brachytherapy procedure, the doctor discusses how it will be performed, how one should prepare for it, what to expect, and about the recovery.
During the Coronary brachytherapy procedure, most people are sedated so that they don’t feel any pain, but are not fully unconscious. A catheter is inserted into the blood vessel and an x-ray is used to guide it to the narrowed artery. A tiny balloon is inflated that helps in widening the narrowed artery. Radiations are delivered to the area of narrowing. The radiations play a role by destroying the cells causing scar tissue. After the procedure, the radiation and catheter are removed.
After the Coronary brachytherapy procedure, some people can go home the same day while a few would need to stay overnight. Rest and strenuous activities are advised to be avoided. Also, medications are given to avoid further clotting.
Benefits of Coronary Brachytherapy
Coronary brachytherapy is performed to treat restenosis in people with coronary artery disease. It can also be an option for people with multiple stents. It can be helpful in preventing heart attack and heart failure and also in preventing the symptoms of coronary artery disease including:
- Nausea
- Lightheadedness
- Fast heart rate
- Chest pain
- Shortness of breath
Risks of Coronary Brachytherapy
Coronary brachytherapy is a very effective option for treating and preventing restenosis.
A study found that there were immediate benefits in people after Coronary brachytherapy procedure but many of them were not able to go home, on the same day of the procedure(2). It was observed that restenosis occurred in people even after coronary brachytherapy (42% after 3 years), but complications such as heart attack and clot formation were rare.
Another risk is the one just similar to any other invasive procedure i.e. risk of infection. It is also important to make the doctor aware of any allergies or any complications with the previous procedure.
Outlook for People with Coronary Brachytherapy
Coronary brachytherapy has good long-term outcomes for people with complex restenosis, but restenosis can occur again(3). It is important for people to continue a heart-healthy lifestyle, which includes:
- Quitting smoking
- Taking a low-fat diet
- Consuming alcohol in moderation
- Being regular with exercises
