Prophylactic endovascular radiotherapy to prevent intimal hyperplasia after stent implantation in femoropopliteal arteries

Liermann, D.; Bottcher, HeinzD.; Kollath, J; Schopohl, B.; Strassmann, Gerd; Strecker, E P; Breddin, K.

doi:10.1007/bf00197908

Cited by 30 publications

(34 citation statements)

References 27 publications

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“…Four cases showed complete occlusion or a significant restenosis. 97) Clinical followup detected a patency of 80% at the treated site at 5 years and none of them reported any adverse effects as a result of the radiation treatment at follow-up of up to 7 years.…”

Section: Peripheral Systemmentioning

confidence: 87%

“…Preliminary clinical studies using gamma radiation in the human iliac restenotic artery, human AV hemodialysis shunt, and human coronary artery have been completed. [92][93][94][95][96] One of the earliest clinical studies demonstrated a beneficial effect of endovascular irradiation in the peripheral circulation. Liermann and coworkers reported preliminary results using endovascular radiation therapy in 35 patients with restenosis after initial stenting in the superficial femoral artery.…”

Section: Peripheral Systemmentioning

confidence: 99%

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<b>Irradiation and Postangioplasty Restenosis</b>

et al. 2000

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SUMMARYOne of the most intriguing developments in recent years towards prevention of restenosis after angioplasty is the use of ionizing radiation. The background for the use of radiation treatment for this application is sound, since radiation is used not only to treat malignant cancerous growths but also is used for treatment of benign hyperplastic disorders such as post-surgical keloid formation and recurrence of pterygium after surgical removal. Restenosis can be considered a form of overexuberant wound healing triggered by angioplasty. Ionizing radiation inhibits serum-stimulated proliferation of many cell types including fibroblasts and smooth muscle cells in vitro and also suppresses the synthesis of collagen by cultured fibroblasts. Liermann who showed inhibition of post-stent restenosis first used ionizing radiation for restenosis prevention clinically in iliac and iliofemoral arteries. Subsequently, extensive animal studies in various restenosis models have shown a profound inhibitory effect of catheter-based radiation (endovascular brachytherapy) on neointima formation and overall vessel shrinkage (negative remodeling). 1) performed the first coronary balloon angioplasty. After more than 20 years, percutaneous transluminal coronary angioplasty (PTCA) is now widely accepted as an effective therapy for selected patients with symptomatic coronary artery disease. However, the over-compensatory wound healing response to angioplasty causing restenosis significantly limits the long-

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Section: Peripheral Systemmentioning

confidence: 87%

Section: Peripheral Systemmentioning

confidence: 99%

<b>Irradiation and Postangioplasty Restenosis</b>

et al. 2000

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“…Finally, a recently reported clinical experience with endovascular irradiation in the peripheral circulation has suggested that this approach may be very effective in preventing human arterial restenosis. 39 Contrary to the findings from the experimental studies19,36-38 and the clinical study, 39 Schwartz et a140 found that x-irradiation modestly increased neointimal hyperplasia in an oversized porcine coronary stent model. These investigators used balloons and stents that were 70% to 100% oversized relative to the reference segment, which may have resulted in a more severe stimulus for neointimal hyperplasia than in the other in vivo studies.…”

Section: Irradiation and Neointimal Hyperplasiamentioning

confidence: 87%

Low-dose, beta-particle emission from 'stent' wire results in complete, localized inhibition of smooth muscle cell proliferation.

et al. 1994

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BACKGROUND Restenosis after catheter-based revascularization has been demonstrated to be primarily caused by medial and/or intimal smooth muscle cell (SMC) proliferation. The objective of this study was investigate the ability of local emission of beta-particles from a 32P-impregnated titanium "stent" wire source to inhibit vascular SMC and endothelial cell proliferation in cell culture and to determine the dose-response characteristics of this inhibition. METHODS AND RESULTS A series of experiments were performed using 0.20-mm-diameter titanium wires that were impregnated with varying low concentrations of 32P (activity range, 0.002 to 0.06 microCi/cm wire, n = 47) or 31P (nonradioactive control, n = 28) in cultures of rat and human aortic SMCs and in cultured bovine aortic endothelial cells. The zone of complete cell growth inhibition (in millimeters from stent wire) was measured using light microscopy in the cultures exposed to the radioactive (32P) or control (31P) wires at 6 and 12 days after plating. In both rat and human SMC cultures there was a distinct 5.5- to 10.6-mm zone of complete SMC inhibition at wire activity levels > or = 0.006 microCi/cm. In contrast, there was no zone of inhibition surrounding the control (31P impregnated) wires (P < .001 versus 32P wires at all wire activities > or = 0.006 microCi/cm for human and rat SMCs). Proliferating bovine endothelial cells were more radioresistant than SMCs, with no zone of inhibition observed at wire activity levels up to 0.019 microCi/cm (P < .001 versus SMCs at 0.006 microCi/cm and 0.019 microCi/cm). CONCLUSIONS We conclude that very low doses of beta-particle emission from a 32P-impregnated stent wire (activity levels as low as 0.006 microCi/cm of wire) completely inhibit the growth and migration of both rat and human SMCs within a range of 5.5 to 10.6 mm from the wire. Endothelial cells appear to be much more radioresistant than SMCs. These data suggest that an intra-arterial stent impregnated with a low concentration of 32P may have a salutary effect on the restenosis process. Whether this approach can be used successfully and safely to inhibit restenosis in vivo and in the clinical setting is under investigation.

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“…In other reports, long-term follow-up has documented high patency rates in femoropopliteal arteries undergoing angioplasty plus intravascular ␥-radiation. 22,23 The SCRIPPS trial obtained angiographic follow-up in 19 patients treated with ␥-radiation at 3 years. There were no perforations, aneurysms, pseudoaneurysms, or other special safety concerns.…”

Section: Long-term Adverse Effectsmentioning

confidence: 99%