Geometric Vascular Remodeling After Balloon Angioplasty and β-Radiation Therapy

Sabaté, Manel; Serruys, Patrick W.; Giessen, Willem J. van der; Ligthart, Jürgen; Coen, V.; Kay, Ian; Gijzel, Anthonie L; Wardeh, Alexander J.; Boer, Ad den; Levendag, Peter C.

doi:10.1161/01.cir.100.11.1182

Cited by 115 publications

(72 citation statements)

References 36 publications

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“…The rationale for the use of radiation therapy for the prevention and treatment of vascular stenosis as a result of neointimal hyperplasia stems from (1) the potent in vitro antiproliferative effect of radiation therapy on smooth muscle cells, endothelial cells, and macrophages (72)(73)(74) and (2) possible beneficial effects on vascular remodeling (vessel wall dilation) (75). Experimental angioplasty models have demonstrated significant reductions in luminal stenosis with endovascular and external beam radiation therapy (76,77), and these findings have been confirmed in large clinical studies of catheter-based radiation therapy for coronary restenosis (78,79).…”

Section: Radiation Therapymentioning

confidence: 99%

Hemodialysis Vascular Access Dysfunction

Roy‐Chaudhury

Sukhatme

Cheung³

2006

Journal of the American Society of Nephrology

505

283

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Hemodialysis vascular access dysfunction is a major cause of morbidity and hospitalization in the hemodialysis population. The major cause of hemodialysis vascular access dysfunction is venous stenosis as a result of neointimal hyperplasia. Despite the magnitude of the clinical problem, however, there has been a paucity of novel therapeutic interventions in this field. This is in marked contrast to a recent plethora of targeted interventions for the treatment of arterial neointimal hyperplasia after coronary angioplasty. The reasons for this are two-fold. First there has been a relative lack of cellular and molecular research that focuses on venous neointimal hyperplasia in the specific setting of hemodialysis vascular access. Second, there have been inadequate efforts by the nephrology community to translate the recent advances in molecular and interventional cardiology into therapies for hemodialysis vascular access. This review therefore (1) briefly examines the different forms of hemodialysis vascular access that are available, (2) describes the pathology and pathogenesis of hemodialysis vascular access dysfunction in both polytetrafluoroethylene grafts and native arteriovenous fistulae, (3) reviews recent concepts about the pathogenesis of vascular stenosis that could potentially be applied in the setting of hemodialysis vascular access dysfunction, (4) summarizes novel experimental and clinical therapies that could potentially be used in the setting of hemodialysis vascular access dysfunction, and, finally, (5) offers some broad guidelines for future innovative translational and clinical research in this area that hopefully will reduce the huge clinical morbidity and economic costs that are associated with this condition.

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Section: Radiation Therapymentioning

confidence: 99%

Hemodialysis Vascular Access Dysfunction

Roy‐Chaudhury

Sukhatme

Cheung³

2006

Journal of the American Society of Nephrology

505

283

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“…5,9 In brief, the segment subject to 3-D reconstruction was examined with a 30-MHz singleelement mechanical transducer IVUS system (ClearView, CVIS; Boston Scientific Corp). ECG-gated 3-D IVUS image acquisition and digitization were performed with a computerized workstation (EchoScan; TomTec).…”

Section: Ivus Image Acquisition Analysis Systemmentioning

confidence: 99%

“…5 An angiogram was performed during contrast injection after positioning of the delivery catheter, and the relation between anatomic landmarks and the 2 radiopaque markers of the radiation source was noted. Typically, the aorto-ostial junction, side branches, stent, or a combination were used as landmarks.…”

Section: Ivus Image Acquisition Analysis Systemmentioning

confidence: 99%

“…4,5 In a 3-dimensional (3-D) volumetric intravascular ultrasound (IVUS) investigation, our group observed a decrease in lumen volume at the edges of the irradiated segment due to an increase in plaque volume not accommodated by vessel enlargement. 5 In all 3 reports, the authors hypothesized that the edge effect was due to the combination of low-dose radiation and balloon-induced injury in the segments adjacent to the irradiated site. Indeed, the potential stimulatory effect of low-dose radiation after injury has been demonstrated in animal studies.…”

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confidence: 99%

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Three-Dimensional Intravascular Ultrasound Assessment of Noninjured Edges of β-Irradiated Coronary Segments

et al. 2000

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Background-The "edge effect," late lumen loss at the margins of the treated segment, has become an important issue in the field of coronary brachytherapy. The aim of the present study was to assess the edge effect in noninjured margins adjacent to the irradiated segments after catheter-based intracoronary ␤-irradiation. Methods and Results-Fifty-three vessels were assessed by means of 3-dimensional intravascular ultrasound after the procedure and at 6-to 8-month follow-up. Fourteen vessels (placebo group) did not receive radiation (sham source), whereas 39 vessels were irradiated. In the irradiated group, 48 edges (5 mm in length) were identified as noninjured, whereas 18 noninjured edges were selected in the placebo group. We compared the volumetric intravascular ultrasound measurements of the noninjured edges of the irradiated vessels with the fully irradiated nonstented segments (IRS, nϭ27) (26-mm segments received the prescribed 100% isodose) and the noninjured edges of the vessels of the placebo patients. The lumen decreased (6 mm 3 ) in the noninjured edges of the irradiated vessels at follow-up (Pϭ0.001). We observed a similar increase in plaque volume in all segments: noninjured edges of the irradiated group (19.6%), noninjured edges of the placebo group (21.5%), and IRS (21.0%). The total vessel volume increased in the IRS in the 3 groups. No edge segment was subject to repeat revascularization. Conclusions-The edge effect occurs in the noninjured margins of radiation source train in both irradiated and placebo patients. Thus, low-dose radiation may not play an important role in this phenomenon, whereas nonmeasurable device injury may be considered a plausible alternative explanation.

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“…However, the rapid decrease in the dose of beta radiation within 2-5mm of depth is associated with a less homogeneous release of the dose 32 . In addition, the "shield effect" produced by the rods of the stent could be associated with an attenuation in the radiation dose through its rods greater than 15% 36 . Comparing the results on intracoronary ultrasound in 2 large studies 13,15 , beta radiation showed a greater benefit than gamma radiation did in preventing neointimal hyperplasia inside the stent 37,38 .…”

Section: Discussionmentioning

confidence: 99%