This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by van der Giessen, W. J. Articles by van Beusekom, H. M.M. Search for Related Content PubMed PubMed Citation Articles by van der Giessen, W. J. Articles by van Beusekom, H. M.M. Pubmed/NCBI databases Substance via MeSH Related Collections Restenosis Catheter-based coronary interventions: stents

(Circulation. 2001;104:2236.)
© 2001 American Heart Association, Inc.

Basic Science Reports

"Edge Effect" of ³²P Radioactive Stents Is Caused by the Combination of Chronic Stent Injury and Radioactive Dose Falloff

Willem J. van der Giessen, MD, PhD;; Evelyn Regar, MD;; Miranda S. Harteveld, BSc; Veronique L.M.A. Coen, MD; Rohit Bhagwandien, MSc; Arthur Au, MSc; Peter C. Levendag, MD, PhD; Jurgen Ligthart, BSc; Patrick W. Serruys, MD, PhD; Ad den Boer, MSc; Pieter D. Verdouw, PhD; Eric Boersma, MSc, PhD; Ty Hu, MD; Heleen M.M. van Beusekom, PhD

From the Department of Cardiology, Thoraxcenter (W.J.v.d.G., E.R., M.S.H., R.B., J.L., P.W.S., A.d.B., P.D.V., E.B., H.M.M.v.B.), and Department of Radiation Oncology, Erasmus Medical Center (V.L.M.A.C., P.C.L.), Rotterdam, the Netherlands; and Guidant Inc, Santa Clara, Calif (A.A., T.H.).

Correspondence to Willem J. van der Giessen, MD, PhD, Department of Cardiology, Thoraxcenter, Bd 412, Erasmus Medical Center Rotterdam, 3015 GD Rotterdam, the Netherlands. E-mail vandergiessen{at}card.azr.nl

Background— Radioactive stents have been reported to reduce in-stent neointimal thickening. An unexpected increase in neointimal response was observed, however, at the stent-to-artery transitions, the so-called "edge effect." To investigate the factors involved in this edge effect, we studied stents with 1 radioactive half and 1 regular nonradioactive half, thereby creating a midstent radioactive dose-falloff zone next to a nonradioactive stent-artery transition at one side and a radioactive stent-artery transition at the other side.

Methods and Results— Half-radioactive stents (n=20) and nonradioactive control stents (n=10) were implanted in the coronary arteries of Yucatan micropigs. Animals received aspirin and clopidogrel as antithrombotics. After 4 weeks, a significant midstent stenosis was observed by angiography in the half-radioactive stents. Two animals died suddenly because of coronary occlusion at this mid zone at 8 and 10 weeks. At 12-week follow-up angiography, intravascular ultrasound and histomorphometry showed a significant neointimal thickening at the midstent dose-falloff zone of the half-radioactive stents, but not at the stent-to-artery transitions at both extremities. Such a midstent response (mean angiographic late loss 1.0 mm) was not observed in the nonradioactive stents (mean loss 0.4 to 0.6 mm; P< 0.01).

Conclusions— The edge effect of high-dose radioactive stents in porcine coronary arteries is associated with the combination of stent injury and radioactive dose falloff.

Key Words: stents • radioisotopes • angioplasty • restenosis

This article has been cited by other articles:

				W. J. van der Giessen, O. Sorop, P. W. Serruys, I. Peters-Krabbendam, and H. M.M. van Beusekom Lowering the Dose of Sirolimus, Released From a Nonpolymeric Hydroxyapatite Coated Coronary Stent, Reduces Signs of Delayed Healing J. Am. Coll. Cardiol. Intv., April 1, 2009; 2(4): 284 - 290. [Abstract] [Full Text] [PDF]

				M. Degertekin, P. A. Lemos, C. H. Lee, K. Tanabe, J.E. Sousa, A. Abizaid, E. Regar, G. Sianos, W. J. van der Giessen, P. J. de Feyter, et al. Intravascular ultrasound evaluation after sirolimus eluting stent implantation for de novo and in-stent restenosis lesions Eur. Heart J., January 1, 2004; 25(1): 32 - 38. [Abstract] [Full Text] [PDF]

				E. Cheneau, R. Waksman, H. Yazdi, R. Chan, J. Fourdnadjiev, C. Berzingi, V. Shah, A. E. Ajani, L. Leborgne, and F. O. Tio How to Fix the Edge Effect of Catheter-Based Radiation Therapy in Stented Arteries Circulation, October 22, 2002; 106(17): 2271 - 2277. [Abstract] [Full Text] [PDF]