Coronary brachytherapy is a procedure that helps prevent your blood vessels from becoming blocked after a stent placement. While this therapy is very effective when it comes to preventing additional blockages, there are risks to the procedure.

This article gives a step-by-step overview of what to expect if you need coronary brachytherapy, plus information on the risks and benefits of this procedure.

Coronary artery disease (CAD) is a condition that develops slowly throughout your life. The risk of developing CAD increases if a person has a family history of the condition. Diet and lifestyle choices are also risk factors.

With CAD, fats like cholesterol and other minerals build up in your blood vessels and form hard coatings called plaque. Over time, plaque can build up to the point where it narrows the vessel, restricting the flow of blood to your vital organs.

In some cases, pieces of these plaques can also break off, causing severe complications like heart attack or stroke.

The most common treatment when blood vessels become blocked with plaque from CAD is to place a stent, which is a small device that helps keep blood vessels open.

While these stents are usually coated with medications designed to reduce the formation of new plaques or scar tissue, blood vessels treated with stents can be complicated by restenosis, or a repeated narrowing of the blood vessel.

Restenosis can be treated in two ways:

  • through the placement of another drug-coated stent inside the first stent
  • with focus radiation therapy inside the blood vessel to clear the blockage (coronary brachytherapy)

Brachytherapy is a form of internal radiation used to treat a number of conditions, including cancer. With this therapy, tiny particles of radiation therapy in the form of capsules or granules are used to destroy things like tumors or other growths and blockages.

When brachytherapy is used for cancer treatment, radiation particles are used to destroy tumors. But with coronary brachytherapy, the procedure has a few more steps.

Before your procedure is even scheduled, you will meet with your doctor or medical team to discuss your condition and possible treatments. If coronary brachytherapy is recommended, your medical care team should talk with you about:

  • why you need coronary brachytherapy
  • how the procedure will be performed
  • who will perform the procedure
  • how you should prepare
  • what to expect during your coronary brachytherapy
  • how you will feel afterward
  • what recovery will be like

On the day of your scheduled procedure, plan to wear comfortable clothing, leave your valuables at home, and have someone drive you to and from the medical facility.

While full anesthesia isn’t required for coronary brachytherapy, some level of sedation or anesthetic is used with most types of brachytherapy. You may be able to go home the same day the procedure is done, but you should plan to rest for a few days.

Below is a list of general steps to expect during your coronary brachytherapy. Your specific procedure may vary based on your condition and the doctor performing the procedure.

  • You will be taken to a treatment area, usually an interventional radiology suite.
  • You will be asked to change into a hospital gown for the procedure.
  • Your medical team will confirm the procedure that is about to be done, the steps that will be taken, any medications that are to be given, and why the procedure is being performed.
  • When it’s time to begin the procedure, you will lie on the procedure table. You should receive some form of sedation or anesthetic to help reduce pain, discomfort, and anxiety during the procedure.
  • A flexible catheter — similar to what is used for a cardiac catheterization — that can reach the blockage is inserted into your body through an artery close to the blocked area, usually in the wrist or groin.
  • Once in place at the area of restenosis, the catheter will use a balloon or similar device to open the blocked vessel.
  • After an opening is formed to expose as much of the vessel as possible, radiation will be delivered to the area to remove and prevent the formation of scar tissue.
  • Radiation is delivered to the area of restenosis for 3 to 5 minutes, and then the catheter is removed, which signals that the procedure is over.

You may be monitored for a short time after your coronary brachytherapy, but you should be able to go home on the same day. For a few days after the procedure, you should plan to rest and limit your physical activity to prevent any complications.

Coronary brachytherapy is usually done to clear blockages in previously placed stents used to treat CAD.

Restenosis occurs in roughly 20% to 50% of people whose CAD was treated with stents alone. Whether restenosis occurs is typically based on the number of stents used, whether they’re multilayered, and whether they’re bare metal or drug-eluting.

Although restenosis has decreased since the introduction of medication-coated stents to reduce the formation of new blockages or scar tissue, these complications still happen. Coronary brachytherapy is usually used once stents have been replaced more than once or twice.

This procedure is very effective at preventing the formation of new blockages.

Coronary brachytherapy is highly effective at treating and preventing restenosis. According to one study published in 2017, immediate benefits were seen in nearly every patient (97%) who had this procedure, and most were able to go home the same day or within a day of treatment.

Although restenosis occurred in some people after coronary brachytherapy (up to 42% after 3 years), serious complications like heart attack or blood clots were rare. As with any invasive procedure, there is also the possibility of infection at the site of catheter insertion or reactions to medications like sedatives or anesthesia.

Talk with your doctor about any problems you encountered during previous surgeries or procedures, as well as any medication allergies before the procedure to reduce your risk of side effects or other complications.

Narrowing of your blood vessels can cause different types of problems, including heart attack and stroke.

While stents are usually the first choice for treating blocked blood vessels from CAD, additional treatments may be needed over time if the same vessels are becoming blocked repeatedly.

Coronary brachytherapy is usually used to clear stents that have been blocked due to several layers of stent. This direct radiation therapy clears scar tissue and can help prevent restenosis — or repeated blockage — of blood vessels in the future.