Drug-eluting stents have made brachytherapy obsolete

This manuscript reviews the controversy regarding the role of intravascular brachytherapy in the setting of growing use of drug eluting stents. The utility of intravascular brachytherapy is being rethought in relation to its use after the placement of drug eluting stents. Even with in-stent stenosis, the role of intravascular brachytherapy is decreasing primarily due to the simplicity of placement of drug eluting stents and the complexity of performing intravascular brachytherapy.

The impact of drug eluting stents is already decreasing the clinical impact of in-stent stenosis. The published pivotal clinical restenosis rates from both the Pacitaxil (TAXUS IV) and Sirolimus (SIRIUS) drug eluting stents suggests that the need to perform intravascular brachytherapy will be in fewer than one in 20 patients. Recently reported registry data from Europe and the United states demonstrates the equivalence drug eluting stent implantation to intravascular brachytherapy for in-stent stenosis of bare metal stents. The role of intravascular brachytherapy for in-stent stenosis of drug eluting stents is very much in question.

This manuscript reviews the impact of Drug Eluting Stents in the practice of interventional cardiology and suggests that the need for intravascular brachytherapy will significantly decrease. Whether we will need this therapy at all is very controversial.