(Circulation. 2001;103:2108.)
© 2001 American Heart Association, Inc.
Basic Science Reports |
Long-Term Effects of Intracoronary ß-Radiation in Balloon- and Stent-Injured Porcine Coronary Arteries
u
a, MD, PhDFrom the Methodist DeBakey Heart Center, Section of Cardiology, Department of Medicine, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Tex; Department of Pathology, Stanford University, Stanford, Calif (L.F.F.); and Department of Pathology, University of Texas Health Science Center, San Antonio, Tex (F.O.T.).
Correspondence to Albert E. Raizner, MD, The Methodist DeBakey Heart Center, Cardiac Catheterization Laboratories, 6535 Fannin, Rm FB1034, Houston TX 77030. E-mail araizner{at}tmh.tmc.edu
Background—The data on the long-term safety and efficacy of intracoronary ß-radiation in animal models are limited.
Methods and Results—A total of 30 coronary arteries in 15 swine were subjected to balloon or stent injury followed by ß-radiation from a centered 32P source (2000 cGy to 1 mm beyond lumen surface) or a sham radiation procedure. The animals received aspirin for 6 months and ticlopidine for 30 days. Five of the 10 animals subjected to radiation died (at 5 days, 7 days, 3 months [n=2], and 4 months) as a result of layered, occlusive thrombus at the intervention site (3 stent and 2 balloon injury sites). No deaths occurred in the control group. In the surviving animals, balloon-injured and irradiated vessels showed a trend toward larger lumens than controls (2.15±0.17 versus 1.80±0.08 mm2, P=0.06) and larger external elastic lamina areas (3.32±0.21 versus 2.62±0.10 mm2, P=0.003). In the stent-injured vessels from surviving animals, lumen, neointimal, and external elastic lamina areas were 3.58±0.33, 3.16±0.35, and 8.12±0.42 mm2 for irradiated vessel segments; these values were not different from those in controls (3.21±0.15, 2.84±0.27, and 7.76±0.28 mm2, respectively). Histologically, healing was complete in most survivors, although intramural fibrin and hemorrhage were occasionally seen.
Conclusion—In the long-term (6 month) porcine model of restenosis, the inhibition by intracoronary ß-radiotherapy of the neointimal formation that is known to be present at 1 month is not sustained. This lack of effect on neointimal formation after balloon and stent arterial injury is accompanied by subacute and late thrombosis that leads to cardiac death on a background of continuous aspirin but relatively brief ticlopidine treatment.
Key Words: angioplasty • stents • restenosis • radiotherapy
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