Pure β-ParticleEmitting Stents Inhibit Neointima Formation in Rabbits

Hehrlein, Christoph; Stintz, Marc Steffen; Kinscherf, Ralf; Schlösser, K.; Huttel, Ehrhard; Friedrich, Ludwig; Fehsenfeld, P.; Kübler, W.

doi:10.1161/01.cir.93.4.641

Cited by 130 publications

(62 citation statements)

References 19 publications

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“…119 At 4 weeks, both groups showed significant reductions in neointimal formation, whereas at 12 weeks, only the group receiving the highest radiation dose showed a significant reduction in neointima compared with nonradioactive stents.…”

Section: Radioactive Stentsmentioning

confidence: 84%

“…The stent used in this trial has subsequently become known as the Fischell IsoStent (IsoStent/Cordis Corp, a Johnson & Johnson Interventional Systems Co. 120 It is a stainless steel Palmaz-Schatz stent that has been modified to be ␤-particle-emitting by ion implantation as described above. Prompted by the encouraging results of ␤-particle-emitting stents on neointimal hyperplasia in animal models, [117][118][119]121,122 a multicenter pilot study examining the feasibility and safety of the implantation of 1-mCi Palmaz-Schatz stents has been completed, and the larger randomized IsoStent for Restenosis Intervention Study (IRIS) trial is under way.…”

Section: Radioactive Stentsmentioning

confidence: 99%

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Frontiers in Interventional Cardiology

1998

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I n more than 20 years since the first percutaneous coronary revascularization procedures, the field of interventional cardiology has proliferated beyond all expectations. Now more than 1 million procedures are performed worldwide each year. Stenting has revolutionized the field, which previously relied on balloon dilatation in the majority of patients. With Ϸ50% of patients now undergoing stent implantation, the groundwork is laid for further important advances. In this article, we discuss the 4 most important new advances in the field of interventional cardiology: platelet inhibition, prevention of restenosis, stent evolution, and angiogenesis.

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Section: Radioactive Stentsmentioning

confidence: 84%

Section: Radioactive Stentsmentioning

confidence: 99%

Frontiers in Interventional Cardiology

1998

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“…68,86,87) Consequently, this same group investigated the effects of stents bombarded with 32 P ions via a mass separator and showed efficacy at 4 weeks and at 12 weeks. 88) A similar technique was independently developed and tested by Fis-chell and co-workers. 67) 31 P was ion-implanted beneath the outer surface of the titanium wire of stents, which were exposed for several hours to a flux of slow neutrons to produce a pure beta-emitter.…”

Section: Radioactive Stents In Animal Studiesmentioning

confidence: 99%

<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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“…Commercially available 15-mm-long balloon-expandable stainless steel stents (Palmaz-Schatz, Cordis, a Johnson & Johnson Co) were rendered radioactive by direct ion implantation of 32 P. 5 The activity of the stent was determined, and stents were allowed to decay to desired 32 P activities before the time of implantation. 3 The dosimetry of 32 P radioactive Palmaz-Schatz stents has previously been reported by Janicki et al 7 The estimated 1-month cumulative dose and initial dose rate at implantation for the 32 P radioactive stents are shown in Table 1.…”

Section: Stent Preparation and Dosimetrymentioning

confidence: 99%

“…2 Hehrlein et al, 5 however, reported a reduction in neointima after 12 weeks in rabbit iliac arteries after placement of radioactive stents with only 13 Ci 32 P. Stents with 4 Ci of 32 P were histologically similar to nonradioactive stents. In the porcine coronary restenosis model, we observed an unusual biphasic biological response to low-(0.5 Ci), intermediate-(1.0 Ci), and high-(Ͼ3.0 Ci) activity 7-mm-long 32 P Palmaz-Schatz stents at 28 days.…”

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confidence: 97%

Dose-Response Effects of ³² P Radioactive Stents in an Atherosclerotic Porcine Coronary Model

et al. 1999

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Background-Experimental studies have demonstrated that 32 P radioactive stents reduce neointimal formation at 28 days in porcine iliac and coronary arteries. Our objective was to determine the long-term dose-response effects of 1.0-to 12.0-Ci 32 P radioactive stents in a porcine atherosclerotic coronary model. Methods and Results-Control (nϭ19) and 1.0-to 12.0-Ci 32 P radioactive (nϭ43) stents (total, nϭ62) were implanted in the coronary arteries of 31 miniature swine at 28 days after creation of a fibrocellular plaque by overstretch balloon injury and cholesterol feeding. Angiography and histomorphometry were performed at 6 months. Stent thrombosis occurred in 3 radioactive (7.7%) and no control stents (Pϭ0.54). On histology, the mean neointimal area and the percent in-stent stenosis correlated positively with increasing stent activity (rϭ0.64, PϽ0.001). The mean neointimal area (mm 2 ) for the stents with Ն3.0 Ci 32 P (3.57Ϯ1.21) was significantly greater than that for the nonradioactive stents (1.78Ϯ0.68, PϽ0.0001). The neointima of the stents with Ն3.0 Ci 32 P was composed of smooth muscle cells, matrix proteoglycans, calcification, foam cells, and cholesterol clefts. Conclusions-Continuous low-dose-rate irradiation delivered by high-activity 32 P radioactive stents promotes the formation of an "atheromatous" neointima after 6 months in this experimental model. These data may be useful for predicting late tissue responses to radioactive stents in human coronary arteries. (Circulation. 1999;100:1548-1554.)

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Pure β-ParticleEmitting Stents Inhibit Neointima Formation in Rabbits

Cited by 130 publications

References 19 publications

Frontiers in Interventional Cardiology

Frontiers in Interventional Cardiology

<b>Irradiation and Postangioplasty Restenosis</b>

Dose-Response Effects of ³² P Radioactive Stents in an Atherosclerotic Porcine Coronary Model

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Pure β-ParticleEmitting Stents Inhibit Neointima Formation in Rabbits

Cited by 130 publications

References 19 publications

Frontiers in Interventional Cardiology

Frontiers in Interventional Cardiology

<b>Irradiation and Postangioplasty Restenosis</b>

Dose-Response Effects of 32 P Radioactive Stents in an Atherosclerotic Porcine Coronary Model

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Dose-Response Effects of ³² P Radioactive Stents in an Atherosclerotic Porcine Coronary Model