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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

ATHERECTOMY COMPLICATIONS

Case ExamplesEducational Content

BYPASS GRAFT COMPLICATIONS

ModelBurst (ATM)Diameter (mm)Balloon Length (mm)              
681215202530
MINI TREK (CTO INDICATED)1.271.2
1.561.5
2.172✓*✓*
TREK2.372.25
2.672.5
2.912.75
3.113
3.53.25
3.73.5
3.943.75
4.324
4.864.5
5.365
*Only available as RX, not as OTW. Other sizes available in both versions.
Retrieved on April 07 2022 from Abbott product ordering information. Please look at the company's files for the latest available data on device configurations and avilability in your area.

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