Intravascular radiation therapy in atherosclerotic disease: promises and premises

Since its introduction in 1977, coronary angioplasty has become an established technique for the treatment of atherosclerotic coronary disease. Currently, more than 500 000 procedures are performed each year worldwide. However, two major problems remain unresolved. The first, post-angioplasty acute vessel closure, occurs in about 5% of cases. In this setting, intracoronary stenting has been very useful for the management of postangioplasty dissections'. The second problem, restenosis, occurs in 30 to 50% of cases. Thus far, drug therapy has shown little benefit in reducing the extent of this phenomenon. Recently, however, the STRESS trial showed that intracoronary stents could reduce restenosis rates from 42% to 32%, and the BENESTENT trial had an even greater reduction: from 32% to 22%. The beneficial effect of stenting is presumably due to better vessel geometry since it induces more neointima formation than balloon angioplasty.