A cutting edge technology, or is it?

Since the first days of angioplasty, restenosis has been the major limitation. Over the brief history of percutaneous interventions, therapies to prevent restenosis have come and gone with a frequency that rivals treatments for rheumatoid arthritis over the last hundred years. We have also learned to be skeptical regarding any claim of benefit from a therapy for established restenosis. In the recently published American Heart Association and the American College of Cardiology Guidelines on Percutaneous Coronary Interventions (1), there are no recommendations for any therapy for restenotic lesions that are not stented. However, since stenting has become the predominant percutaneous coronary artery intervention, the most common form of restenosis is currently in-stent restenosis. There is now an approved treatment for this condition— endovascular brachytherapy. Three randomized trials, two using beta radiation (START, INHIBIT) and one using gamma radiation (GAMMA-1), have shown significant reduction in re-restenosis of treated in-stent lesions that receive radiation therapy. Before brachytherapy can be delivered, mechanical removal or displacement of the obstructing lesion must be done. Also pertinent is the fact that