Rotational atherectomy has been shown to be safe and efficient for the treatment of (ISR), however the recurrence rate remains high. Intracoronary β irradiation following rotational atherectomy may be a reasonable approach for prevention of recurrent ISR.

Fifty consecutive patients with diffuse ISR (length>10 mm) in native coronary arteries underwent rotational atherectomy and adjunctive balloon angioplasty followed by β irradiation using a 188Re-MAG3-filled balloon catheter. The radiation dose was 15 Gy at 1.0 mm deep into vessel wall.

The mean length of the lesion and the irradiated segment was 25.6±12.7 mm and 37.6±11.2 mm, respectively. The radiation was delivered successfully to all patients, with a mean irradiation time of 201.8±61.7 seconds. No adverse events such as myocardial infarction, death, or stent thrombosis occurred during the follow-up period (mean 10.3±3.7 months) although non-target vessel revascularization was required in one patient. The six-month binary angiographic restenosis rate was 10.4% and the loss index was 0.17±0.31.

β irradiation using a 188Re-MAG3-filled balloon following rotational atherectomy is safe and feasible for patients with diffuse ISR, and it may improve the clinical and angiographic outcomes. Further prospective randomized trials are warranted in order to evaluate the synergistic effect of debulking and irradiation in patients with diffuse ISR.