Adjunct brachytherapy: a new concept to prevent intimal hyperplasia after surgical endarterectomy?

Beller, Carsten J.; Kosse, Jens; Radovits, Tamás; Krempien, Robert; Gross, Marie-Luise; Berger, Irina; Hagl, Siegfried; Szabó, Gábor
March 2006
European Journal of Cardio-Thoracic Surgery;Mar2006, Vol. 29 Issue 3, p334
Academic Journal
Abstract: Objective: Endarterectomy represents a therapeutical option for patients with advanced coronary artery disease. The mid-term results are compromised by restenosis due to neointima formation. The aim of this study was to evaluate a new treatment concept – endarterectomy with consecutive gamma-irradiation – in a rat model. Methods: Male Sprague–Dawley rats underwent left carotid endarterectomy with removal of intima: control (n =10) or were irradiated with 15Gray (Gy) (n =13) or 20Gy (n =10) postoperatively and compared with sham-operated rats (n =10). After 3 weeks, carotid arteries were perfusion-fixed and vessel compartment areas were measured. Transmission electron microscopy and immunohistochemical staining were used to confirm neointima formation. Results: Three weeks after endarterectomy, neointimal hyperplasia was found in the control group (0.07±0.04mm2). After irradiation, a dose-dependent reduction of neointima was observed (0.003mm2 at 15Gy and 0.0007mm2 at 20Gy, P <0.0001). However, immunohistochemical staining revealed that thin re-endothelialization after irradiation was not inhibited. Conclusions: Gamma-irradiation significantly suppressed neointimal hyperplasia in a rat model of surgical endarterectomy. Despite inhibition of intimal hyperplasia, re-endothelialization after adjuvant brachytherapy was present. Adjuvant brachytherapy may be therefore a new concept to prevent restenosis after endarterectomy in patients.


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