192Ir endovascular brachytherapy for avoidance of intimal hyperplasia after percutaneous transluminal angioplasty and stent implantation in peripheral vessels: 6 years of experience

Schopohl, B.; Liermann, D.; Pohlit, Lotte Jülling; Heyd, Reinhard; Strassmann, Gerd; Bauersachs, Rupert; Schulte-Huermann, D; Rahl, Claus Guido; Manegold, Karl-Heinz; Kollath, J; Böttcher, H.D.

doi:10.1016/s0360-3016(96)00435-x

Cited by 101 publications

(28 citation statements)

References 16 publications

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“…Another concept could be radiation therapy analogous to intravascular applications [17]. The effect of intraluminal irradiation on TIPS was recently evaluated in an animal model by Lessie et al [18].…”

Section: Discussionmentioning

confidence: 99%

Covered stents in transjugular portosystemic shunt: healing response to non-porous ePTFE covered stent grafts with and without intraluminal irradiation

et al. 2002

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The aim of this study was to evaluate the healing response to a new commercially available ePTFE-covered stent graft used to create transjugular intrahepatic portosystemic shunts (TIPS) in an animal model with and without intraluminal irradiation. The study was designed for ten domestic normotensive pigs. The TIPS was created using a ePTFE-covered stent graft (Viatorr, Gore, Flagstaff, Ariz.). Five animals were scheduled for intraluminal irradiation with iridium 192 immediately after TIPS creation with a dosage of 18 Gy. Shunt venograms were performed every 2 weeks. Animals from the irradiated and non-irradiated group were killed at 2-week intervals. Maximum follow-up was planned for 8 weeks in each group, with two animals in reserve. Gross specimen evaluation and histological examination, including scanning electron microscopy, was performed. Two animals died from interventional complications. In the irradiation group, one shunt occlusion and one stenosis occurred after 2 weeks. The stenosis regressed until the end of the 8-week follow-up period and probably was caused by a resolving thrombus. In the non-irradiated group, no shunt dysfunction was observed. One animal died early due to encephalopathy. Histology revealed an increased inflammatory reaction in the irradiation group, a lesser degree of incorporation of the stent graft, and a lesser degree of endothelialization of the inner surface compared with the non-irradiated group. No significant foreign body reaction was found at any time in any of the animals. The Viatorr stent graft was well tolerated in the pig model. Intraluminal irradiation seemed to have an adverse effect on the healing response. The TIPS patency was prolonged in both the irradiated and non-irradiated group compared with data from the literature; however, seemingly better results were observed in the non-irradiated group.

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Section: Discussionmentioning

confidence: 99%

Covered stents in transjugular portosystemic shunt: healing response to non-porous ePTFE covered stent grafts with and without intraluminal irradiation

et al. 2002

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“…The stenosis is trealed by percutaneous transluminal (coronary) angioplasty (PTCA) and other interventional procedures. But, in about half of the cases, restenosis occurs within a few months [4,16,18] even not after 6 years of clinical observations [38]. They are expected, however, flora late complications -due to microvascular damage -developing after 10 years for high dose irradiation of the heart (e. g. in treatment of lymphoma of breast cancer) [3,14,15,24,44] with an incidente of a few percent at 40 Gy and ~40% at 60 Gy (fractionated) of from single fraction intra-operative radiotherapy of the aorta with high doses exceeding 40 Gy [37].…”

Section: Endovascular Brachytherapy To Reduce Restenosismentioning

confidence: 96%

Endovascular brachytherapy — Treatment planning and radiation protection

Quast

Flühs

Bambynek

1998

Herz

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The risk of restenosis, main late effect limiting the success of percutaneous transluminal coronary artery angioplasty, can be reduced significantly by vascular radiotherapy, subsequent to PTCA. This discovery lead to the development of new irradiation techniques. Endovascular brachytherapy is the choice in treatment of coronary artery stenosis. Successful irradiation, however, requires precise treatment planning. This review addresses the physical possibilities and problems of intravascular brachytherapy planning, and the radiobiologically based definition of the target volume and of structures at risk. Recommendations for dose specification, recording and reporting are given. The criteria for selecting a vascular radiotherapy technique are discussed as well as the possibilities of dosimetric treatment planning and quality assurance based on precise plastic scintillator dosimetry and intravascular ultrasound. Radiation protection and safety must be reconsidered prior to the usage of therapeutic radiation sources in the catheter laboratory and for the decision about emergency plans. Finally, the design of clinical trials, the role of medical physicists, and the future of irradiation treatment of stenosis is discussed.

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“…A gamma source of radiation ( 192 iridium) at a dose of 12 Gy was delivered to the vessel wall by a Nucletron MicroSelectron High Dose Radiation afterloader via a 5 French (Fr) noncentering, closed end-lumen catheter. The treatment was well tolerated with a long-term vessel patency rate of 84% (21 of 25 patients, follow-up of 8 to 71 months) based on Doppler ultrasound [54].…”

Section: Endovascular Radiation Brachytherapymentioning

confidence: 96%

“…From 1990 through 1996, they enrolled 28 patients with instent restenotic lesions in the femoropopliteal arteries to receive EVBT after re-PTA or directional atherectomy of the stented segment [53,54]. A gamma source of radiation ( 192 iridium) at a dose of 12 Gy was delivered to the vessel wall by a Nucletron MicroSelectron High Dose Radiation afterloader via a 5 French (Fr) noncentering, closed end-lumen catheter.…”

Section: Endovascular Radiation Brachytherapymentioning

confidence: 99%

Potential emerging therapeutic strategies to prevent restenosis in the peripheral vasculature

Schainfeld

2002

Cathet Cardio Intervent

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Despite the availability of antiplatelet and antithrombotic therapies, recent advances in catheter and stent technology and improved operator skill, restenosis remains the most frequent problem associated with percutaneous and surgical revascularization interventions for both coronary and peripheral arterial disease. Prevention of restenosis in the coronary vasculature has been demonstrated with cilostazol, trapidil, probucol, tranilast, nitric oxide donors, and clopidogrel. Given the similarities in revascularization procedures and in the pathophysiology of restenosis, it is possible that these results may be extrapolated to the setting of restenosis in the peripheral vasculature, making trials with these agents imperative. Several new agents have shown promising preliminary results for the prevention of restenosis in the peripheral vasculature, including cilostazol, low-molecular-weight heparins, and elastase. Several nonpharmacologic treatment modalities are also under study to prevent peripheral and coronary restenosis and have shown favorable initial results. These include endovascular radiation brachytherapy, arterial gene therapy, photoangioplasty, and several novel treatment delivery systems.

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192Ir endovascular brachytherapy for avoidance of intimal hyperplasia after percutaneous transluminal angioplasty and stent implantation in peripheral vessels: 6 years of experience

Cited by 101 publications

References 16 publications

Covered stents in transjugular portosystemic shunt: healing response to non-porous ePTFE covered stent grafts with and without intraluminal irradiation

Covered stents in transjugular portosystemic shunt: healing response to non-porous ePTFE covered stent grafts with and without intraluminal irradiation

Endovascular brachytherapy — Treatment planning and radiation protection

Potential emerging therapeutic strategies to prevent restenosis in the peripheral vasculature

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