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(Circulation. 2000;101:350.)
© 2000 American Heart Association, Inc.

Editorial

Intracoronary Radiation

It Keeps on Glowing

David O. Williams, MD; Barry L. Sharaf, MD

From the Division of Cardiology, Department of Medicine, Rhode Island Hospital, Brown University, School of Medicine, Providence, RI.

Correspondence to David O. Williams, MD, Division of Cardiology, APC 814, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903. E-mail DOWilliams@lifespan.org

Key Words: coronary angioplasty • Editorials • radiotherapy • restenosis • revascularization • stents

Stents are now used routinely for catheter-based coronary revascularization procedures. Early clinical trials of stents demonstrated reduced rates of angiographic restenosis compared with balloon angioplasty alone.^{1 2 3} In a registry analysis of 1403 patients, 64% of whom were treated with stents, the need for repeat revascularization was 39% less than in a similar cohort having coronary intervention in the prestent era.⁴ In addition to enhancing the durability of coronary angioplasty, stents appear to improve its safety. As stent usage has increased further, the rates of abrupt artery closure and complex dissection associated with catheter-based interventions have declined progressively from 2% to 1% and from 11% to 5%, respectively.⁵ Stents have also expanded the pool of patients suitable for nonsurgical revascularization. Lesions that are treated currently are longer and are located in more tortuous and smaller arteries.

Although stents substantially reduce the relative risk for lesion recurrence, the absolute chance of experiencing restenosis is still significant. Furthermore, when restenosis occurs within a stent, conventional treatments are of limited value, as repeat in-stent restenosis is observed in 54% to 66% of patients.^{6 7 8} There have been many attempts to improve on these results by placing a new stent within the original stent and supplementing repeat balloon angioplasty with excimer laser, high-speed rotational atherectomy and directional atherectomy. None of these strategies, however, have proved particularly successful.

Studies using intracoronary ultrasound have demonstrated that in-stent restenosis is due to neointimal tissue proliferation.⁹ Considering that radiation has been effective in the treatment of other hyperplastic disorders, both . . . [Full Text of this Article]

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