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

AbstractPurpose: Recurrent stenosis or occlusion by intimal hyperplasia occurs in up to 40% of patients with tantalum stent implantations in femoropopliteal arteries and greatly restricts their usefulness. We evaluated the effect of prophylactic endovascular radiotherapy on stenosed/occluded\ stents. Methods: We investigated prophylactic endovascular radiotherapy with a surface dose of 12 Gy using an iridium 192 source as a means to reduce or eliminate recurrent stenosis in 4 patients with stenosed/occluded stents, 6–8 months after the original implantation. Confirmatory diagnostic atherectomy, PTA or laser recanalization and endovascular radiotherapy were performed. Results: None of the four has developed recurrent obstruction within 23 to 30 months after this treatment, which up to now shows no short-term or long-term complications. Conclusion: We conclude that this limited experience is promising enough to warrant further study.

[1]  A. Kruger [Keloids and their treatment with special reference to the radiotherapy]. , 1954, Strahlentherapie.

[2]  A. Imparato,et al.  Intimal and neointimal fibrous proliferation causing failure of arterial reconstructions. , 1972, Surgery.

[3]  F. Veith,et al.  Intimal Injury and Regrowth in the Rabbit Aorta: MEDIAL SMOOTH MUSCLE CELLS AS A SOURCE OF NEOINTIMA , 1975, Circulation research.

[4]  M. Salter,et al.  Postoperative irradiation in the prevention of keloids. , 1976, AJR. American journal of roentgenology.

[5]  A. Clowes,et al.  Suppression by heparin of smooth muscle cell proliferation in injured arteries , 1977, Nature.

[6]  J. Deweese,et al.  Steroids and immunosuppression. Effect on anastomotic intimal hyperplasia in femoral arterial dacron bypass grafts. , 1979, Archives of surgery.

[7]  D. Kramsch,et al.  Suppression of experimental atherosclerosis by the Ca++-antagonist lanthanum. Possible role of calcium in atherogenesis. , 1980, The Journal of clinical investigation.

[8]  G. Wolf,et al.  New rabbit atherosclerosis model for the investigation of transluminal angioplasty. , 1981, Investigative radiology.

[9]  R. Rosenberg,et al.  Cultured endothelial cells produce heparinlike inhibitor of smooth muscle cell growth , 1981, The Journal of cell biology.

[10]  The mechanism of angioplasty. Dilatation of iliac cadaver arteries with intravascular pressure control. , 1982, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[11]  New rabbit atherosclerosis model for the investigation of transluminal angioplasty. , 1982, Investigative radiology.

[12]  J. Palmaz,et al.  Postoperative carotid restenosis due to neointimal fibromuscular hyperplasia. Clinical, angiographic, and pathological findings. , 1983, Radiology.

[13]  K Amplatz,et al.  Nonsurgical placement of arterial endoprostheses: a new technique using nitinol wire. , 1983, Radiology.

[14]  F. Largiadèr,et al.  Radiological follow-up of transluminally inserted vascular endoprostheses: an experimental study using expanding spirals. , 1984, Radiology.

[15]  T. Ryan,et al.  Restenosis following transluminal angioplasty in experimental atherosclerosis. , 1984, Arteriosclerosis.

[16]  J. Palmaz,et al.  Expandable intraluminal graft: a preliminary study. Work in progress. , 1985, Radiology.

[17]  C. Heldin,et al.  Arterial smooth muscle cells in primary culture produce a platelet-derived growth factor-like protein. , 1985, Proceedings of the National Academy of Sciences of the United States of America.

[18]  C. Charnsangavej,et al.  Percutaneous endovascular stents: an experimental evaluation. , 1985, Radiology.

[19]  H. Hämmerle,et al.  Inhibition of smooth muscle cell proliferation and endothelial permeability with flunarizine in vitro and in experimental atheromas , 1985, Research in experimental medicine. Zeitschrift fur die gesamte experimentelle Medizin einschliesslich experimenteller Chirurgie.

[20]  Kombinierte intraduktale und perkutane Radiotherapie bei maligner Gallenwegsobstruktion mit anschließender prothetischer Versorgung , 1987 .

[21]  C. Charnsangavej,et al.  Self-expanding metallic stents for small vessels: an experimental evaluation. , 1987, Radiology.

[22]  F Joffre,et al.  Self-expanding endovascular prosthesis: an experimental study. , 1987, Radiology.

[23]  F Joffre,et al.  Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. , 1987, The New England journal of medicine.

[24]  C. Charnsangavej,et al.  Self-expanding metallic stents: preliminary evaluation in an atherosclerotic model. , 1987, Radiology.

[25]  E. Gillette,et al.  Peripheral neuropathies following experimental intraoperative radiation therapy (IORT). , 1989, International journal of radiation oncology, biology, physics.

[26]  H. Rousseau,et al.  Self-expanding endovascular stent in experimental atherosclerosis. Work in progress. , 1989, Radiology.

[27]  [Results of scar keloid prevention using contact irradiation with strontium 90]. , 1989, Rontgenpraxis; Zeitschrift fur radiologische Technik.

[28]  F. Sacks,et al.  RANDOMISED TRIAL OF FISH OIL FOR PREVENTION OF RESTENOSIS AFTER CORONARY ANGIOPLASTY , 1989, The Lancet.

[29]  R. Günther,et al.  Iliac and femoral artery stenoses and occlusions: treatment with intravascular stents. , 1989, Radiology.

[30]  D. Dichek,et al.  Seeding of intravascular stents with genetically engineered endothelial cells. , 1989, Circulation.

[31]  H. Baumgartner,et al.  Inhibitors of angiotensin-converting enzyme prevent myointimal proliferation after vascular injury. , 1989, Science.

[32]  W J Penny,et al.  Effects of thrombin inhibition on the development of acute platelet-thrombus deposition during angioplasty in pigs. Heparin versus recombinant hirudin, a specific thrombin inhibitor. , 1989, Circulation.

[33]  J. Triller,et al.  Die vaskuläre Endoprothese bei femoro-poplitealer Verschlußkrankheit , 1989 .

[34]  R. Virmani,et al.  Flexible tantalum stents implanted in aortas and iliac arteries: effects in normal canines. , 1990, Radiology.

[35]  A new, biocompatible polymeric coronary stent: design and early results in a pig model , 1990 .

[36]  E. Nabel,et al.  Site-specific gene expression in vivo by direct gene transfer into the arterial wall. , 1990, Science.

[37]  K. Robinson,et al.  Trapidil in preventing restenosis after balloon angioplasty in the atherosclerotic rabbit. , 1990, Circulation.

[38]  M. Savage,et al.  A controlled trial of corticosteroids to prevent restenosis after coronary angioplasty. M-HEART Group. , 1990, Circulation.

[39]  J. Wilcox,et al.  Analysis of local gene expression in human atherosclerotic plaques by in situ hybridization. , 1991, Trends in cardiovascular medicine.

[40]  E. Betz,et al.  WIRKUNG VON DIHAMATOPORPHYRIN-DERIVATEN AUF KULTIVIERTE GLATTE MUSKELZELLEN DES MENSCHEN AUS NORMALEN UND ATHEROSKLEROTISCH VERANDERTEN GEFASSSEGMENTE N-UBERSICHT UBER BISHERIGE ERGEBNISSE UND IMPLIKATIONEN FUR EINE PHOTODYNAM ISCHE THERAPIE , 1991 .

[41]  P. Dartsch,et al.  [Effect of dihematoporphyrin derivatives on cultivated human smooth muscle cells from normal and atherosclerotic vascular segments-- Overview of results and implications for photodynamic therapy]. , 1991, Zeitschrift fur Kardiologie.

[42]  D. Faxon,et al.  Low molecular weight heparin (enoxaparin) reduces restenosis after iliac angioplasty in the hypercholesterolemic rabbit. , 1991, Journal of the American College of Cardiology.

[43]  F. Bühler,et al.  Blood Pressure Control by the Renin‐Angiotensin System in Normotensive Subjects: Assessment by Angiotensin Converting Enzyme and Renin Inhibition , 1992, Circulation.

[44]  D. Baim,et al.  Evidence Implicating Nonmuscle Myosin in Restenosis: Use of In Situ Hybridization to Analyze Human Vascular Lesions Obtained by Directional Atherectomy , 1992, Circulation.

[45]  G. Sicard Site-specific gene expression in vivo by direct gene transfer into the arterial wall: Nabel EG, Plautz G, Nabel GJ. Science 1990; 249: 1285-8 , 1993 .