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(Circulation. 2003;107:2153.)
© 2003 American Heart Association, Inc.

Basic Science Reports

Time Course of Stent Endothelialization After Intravascular Radiation Therapy in Rabbit Iliac Arteries

Edouard Cheneau, MD; Michael C. John, BA; Jana Fournadjiev, PhD; Rosanna C. Chan, PhD; Han-Soo Kim, MD; Laurent Leborgne, MD; Rajbabu Pakala, PhD; Hamid Yazdi, MD; Andrew E. Ajani, MD; Renu Virmani, MD; Ron Waksman, MD

From the Cardiovascular Research Institute, Washington Hospital Center, and the Armed Forces Institute of Pathology (M.C.J., R.V.), Washington, DC.

Correspondence to Ron Waksman, MD, Washington Hospital Center, 110 Irving St, NW, Suite 4B-1, Washington, DC 20010. E-mail ron.waksman{at}medstar.net

Background— Late total occlusion after vascular brachytherapy (VBT) continues to be a serious complication. Delayed reendothelialization was suggested as a pivotal cause, but the time course for complete healing is unknown.

Methods and Results— Seventy-two rabbit iliac arteries underwent stent implantation and were treated with -radiation using ¹⁹²Ir. The prescribed doses were 0 Gy (controls, n=24 arteries), 15 Gy (n=24), or 30 Gy (n=24) at 2 mm. Animals were killed at 1 month (n=24), 3 months (n=24), or 6 months (n=24) and were analyzed for histomorphometry or scanning electron microscopy. Intimal area was reduced after VBT at 3 months with 15 and 30 Gy (0.66±0.07 and 0.66±0.04 mm², respectively) compared with controls (1.01±0.11 mm², P<0.05) and at 6 months with 30 Gy (0.75±0.09 versus 1.28±0.26 mm² in controls, P<0.01). Intimal area was similar at 6 months between 15 Gy and controls. At 1 month, 92±4% of the control stented segment was covered with endothelial cells, whereas only 37±4% and 37±8% was covered in the 15- and 30-Gy arteries, respectively. Similarly, at 3 and 6 months, there was a difference in the extent of reendothelialized areas (at 3 months, 95±2%, 32±12%, and 29±13%; and at 6 months, 98±2%, 40±8%, and 35±12% in control, 15-Gy, and 30-Gy arteries, respectively). Excess platelets and leukocytes were seen in irradiated arteries without complete coverage of endothelium.

Conclusions— Reendothelialization after VBT is not completed at 6 months after VBT. Special care with prolonged antiplatelet therapy should be considered beyond that time point.

Key Words: brachytherapy • stent • endothelium • thrombosis

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