Since the introduction of percutaneous coronary interventions, the restenosis has been a major limitation of this therapeutic technique. Until recently, multiple mechanical and pharmacological interventions have proven ineffective in reducing restenosis in a systematic and convincing fashion. Consequently, the interventional community turned their attention to radiotherapy, which has an established role for the treatment of various neoplastic diseases. After several years of extremely rapid development, the first randomized trials of intravascular radiotherapy have been completed with unprecedented success in reducing restenosis after percutaneous coronary interventions. New catheter-based delivery systems for intracoronary use are currently being developed and the first devices for delivery of intravascular radiation therapy have been made commercially available in multiple countries. In response to the growing enthusiasm for this approach, studies on larger populations are needed to determine whether this new strategy will influence the restenosis rate and clinical events after angioplasty and, in a broader sense, the field of interventional cardiology.