In this issue of Cardiovascular Revascularization Medicine , Salihu and colleagues report the very long-term follow-up (20-years) of a cohort of patients treated with intravascular brachytherapy (IVB) for in-stent-restenosis [ ]. The results are sobering, and suggest that, at best, intravascular brachytherapy may provide a relatively short-term beneficial effect in patients with advanced coronary disease who have in-stent restenosis. However, at 20-year follow-up, two-thirds of these patients are dead, and 96 % have had MACE. There are significant limitations with this report, as pointed out by the authors. In particular, we have no control group with patients having similar risk factors and advanced coronary artery disease for comparison with regard to the Hazard plot.