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Intravascular Brachytherapy

Mechanism: locally applied radiation can block or attenuate local tissue proliferation causing ISR.
Indication: to reduce the recurrence of in-stent restenosis (ISR).

Possible negative effects of brachytherapy:

  • Delayed recurrent restenosis
  • Late stent thrombosis because of prolonged inhibition of intimal formation
  • Late vessel stent separation because of positive remodeling
  • Geographical miss: reactive hyperproliferation at the edges because of less radiation dose

Types of brachytherapy: both gamma (low energy/high penetration) using 192-Ir and beta sources (high energy/low penetration) are effective, but only the beta source is clinically available
FDA-approved brachytherapy systems:

  • Gamma: Cordis Checkmate (192-Ir)™ (not commercially available)
  • Beta: Guidant Galileo (32-P)™ (not commercially available) and (Novoste Beta-Cath (90-Sr-Y)™


Novoste Beta-Cath™

  • Guide selection: 6 F
  • Wire: 0.014″
  • Distal 1 cm rapid exchange length
  • Selection of device and steps:
    • Appropriate source train length (30 mm, 40 mm, or 60 mm) is selected based on the injury length and desired margin
  • Balloon predilation of ISR is done
  • No stent should be placed when IVBT is planned because of an increased risk of stent thrombosis
  • Dual antiplatelet is continued for at least 3 years
  • For a long lesion, serial delivery of catheters with a 1 mm overlap is recommended. We recommend adequate anticoagulation with bivalirudin (to an ACT of >300) and an additional dose of heparin IV just before delivery of the radiation dose.
Case ExamplesEducational Content


Case ExamplesEducational Content



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