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(Circulation. 2001;104:2459.)
© 2001 American Heart Association, Inc.

Basic Science Reports

Intracoronary ß-Radiation Exacerbates Long-Term Neointima Formation in Balloon-Injured Pig Coronary Arteries

Patrick K. Coussement, MD; Hector de Leon, MD, PhD; Takafumi Ueno, MD, PhD; Mahomed Y. Salame, MD; Spencer B. King, III, MD; Nicolas A.F. Chronos, MD; Keith A. Robinson, PhD

From the Atlanta Cardiovascular Research Institute, Norcross, Ga (P.K.C., H.D.L., T.U., S.B.K., N.A.F.C., K.A.R.), and the Medical College of Georgia, Augusta (M.Y.S., N.A.F.C., K.A.R.).

Correspondence to Keith A. Robinson, PhD, the Atlanta Cardiovascular Research Institute, 3155 Northwoods Place, Norcross, GA 30071. E-mail krobinson{at}acri.com

Background— Long-term biological effects of ionizing radiation on coronary arteries remain poorly defined. We examined late arterial responses 6 months after balloon angioplasty and ß-radiation in normal pig coronary arteries.

Methods and Results— Coronary arteries of 25 adult pigs were randomized to receive 20 Gy (n=8) or 30 Gy (n=9) of ¹⁸⁶Re ß-radiation or sham radiation (n=8) immediately after balloon angioplasty. Aspirin was given daily during follow-up. The study vessels were analyzed histopathologically at 6 months. ß-Radiation decreased lumen area (20 Gy, 1.55±0.99 mm²; 30 Gy, 1.03±0.82 mm²; and 0 Gy, 2.05±0.80 mm²; P<0.05) but not overall vessel area. The neointimal area was significantly larger within the injured segment with ß-radiation (20 Gy, 1.92±1.23 mm²; 30 Gy, 1.51±0.97 mm²; and 0 Gy, 0.89±0.31 mm²; 0 Gy versus 20 Gy, P<0.05), and a significant increase of edge stenosis was observed with ß-radiation. Irradiated vessels also had larger thrombus areas within the neointima (30 Gy, 0.24±0.61 mm²; 20 Gy, 0.98±1.57 mm2; and 0 Gy, 0.00±0.01 mm²; P<0.05) and larger adventitial areas (20 Gy, 2.25±0.75 mm²; 30 Gy, 2.38±0.98 mm²; and 0 Gy, 1.23±0.29 mm²; 0 Gy versus 20 or 30 Gy, P<0.05) that showed substantial collagen accumulation.

Conclusions— Intracoronary ß-radiation did not inhibit neointima formation in balloon-injured normal pig coronary arteries 6 months after the interventional procedure. Unresorbed thrombus contributed to, but was not the sole component of, augmented neointima formation. Irradiated vessels demonstrated more adventitial thickening and fibrosis. These observations may have relevance for long-term clinical outcomes after intracoronary ß-radiation.

Key Words: angioplasty • restenosis • radioistopes • pathology

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