Balloon angioplasty is the most common treatment to open clogged arteries and restore blood flow to the heart. Over 1 million times a year, doctors thread a balloon-tipped catheter into a diseased artery and inflate it to clear out fats and plaque buildup.
Angioplasty has several advantages over traditional coronary artery bypass surgery to widen narrowed blood vessels (a condition called stenosis)—it’s minimally invasive, doesn’t require general anesthesia, is less costly and usually leads to speedier recoveries.
But the therapy has one complication that impedes full recovery in about 20 percent to 40 percent of cases—the artery begins closing up again after a few months. When this happens, doctors say the patient has developed restenosis, requiring another angioplasty or, occasionally, surgery itself.
Restenosis actually may occur as a result of microscopic tearing of artery walls that occurs during the procedure. During the healing process, the body sometimes overproduces scar tissue at the site, making arteries narrow again. Placing a metallic mesh tube, called a stent, into the artery will often help it stay open, but even in-stent restenosis can occur.
One promising method to prevent in-stent restenosis is coronary brachytherapy. Using a catheter, doctors place radioactive pellets against the artery wall right after it’s been reopened by balloon angioplasty. These “bullets” release a controlled dose of beta or gamma radiation that inhibits the growth of smooth muscle cells in artery walls and prevents reclosure. Depending on the desired dosage, the pellets are left in place for up to 45 minutes.
Brachytherapy procedures prevent in-stent coronary restenosis in some people. However, the therapy isn’t a one-size-fits-all treatment. Patients who have significant underlying conditions, such as diabetes, multiple blockages in the coronary arteries or widespread cardiovascular disease, may not be well-suited for the procedure.
Brachytherapy has also been linked to an increased risk of blood clots.
Finally, the procedure has been Food and Drug Administration-approved only since 2000, and experts caution that no one knows what the long-term effects of brachytherapy might be. That said, early results are encouraging. Recent studies have found that brachytherapy can cut the need for repeat procedures by up to one-half. It apparently does not harm nearby healthy tissue or produce side effects.
Still, brachytherapy, angioplasty, surgery and stents don’t control the underlying condition—coronary artery disease. Do everything you can to avoid heart disease in the first place by practicing heart-healthy habits like eating a low-fat diet that’s rich in fruits and vegetables, controlling your weight, avoiding cigarettes and getting 30 minutes of exercise almost every day.