Coronary aneurysm after endovascular brachytherapy: true or false?

Brachytherapy: True or False? To the Editor: We read with great interest the article about the mechanism of action of endovascular brachytherapy after balloon angioplasty published by Sabaté et al.1 Intravascular ultrasound (IVUS) imaging provides an extremely effective means of examining vessel changes after interventions and it seems to be critical in the objective evaluation of radiation therapy for restenosis.2 Angiographic follow-up of patients in several trials revealed a few cases of coronary or peripheral aneurysms.3 Ensuing speculations have questioned whether these malformations were true or false aneurysms. These entities have different prognoses. IVUS might help differentiate between true and false aneurysm.4 We previously reported that endovascular radiation might prevent or delay the early resolution of coronary dissection.5 It would be of great interest to know whether the aneurysm development was linked to an early dissection and if it was a true or false aneurysm on the basis of IVUS findings. Finally, the benefits of 3D reconstruction are significant after a therapy like radiation that seeks to inhibit the proliferation of neointimal cells. However, when assessing localized phenomena, such as the flow-limiting site in a restenotic lesion, or the site of malformation, such as an aneurysmal dilatation or dissection, the 2D approach has significant advantages. In this situation, in which all these features are of such interest, a combined 2D and 3D analysis would be invaluable for a better understanding of this novel therapy.