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(Circulation. 2000;101:3.)
© 2000 American Heart Association, Inc.

Editorials

I Like the Candy, I Hate the Wrapper

The ³²P Radioactive Stent

Patrick W. Serruys, MD, PhD; I. Patrick Kay, MBChB

From the Thoraxcenter, Rotterdam, The Netherlands.

Key Words: Editorials • radioisotopes • stents • restenosis • coronary disease

United States patent 5059166, issued October 22, 1991, to Robert and Tim Fischell, described an "intraarterial stent with the capability to inhibit intimal hyperplasia."¹ The proponents of this patent went on to say in their proposal: "Since radiation from a radioisotope source is capable of selectively inhibiting the growth of hyperproliferating cells as compared with normal cells, a radioisotope material which forms part of the stent can be used to decrease the rate of arterial reclosure. The radioisotope could be placed inside the stent, alloyed into the metal from which the stent is made, or preferably, it can be coated onto the stent’s exterior surface." So began the story of the radioactive stent. Eight years and several animal species later, we are becoming aware of the bright and dark sides of this treatment modality in the human model.

The safety and efficacy study by Albiero and colleagues² describes the dose-related decrease noted at 6-month follow-up of intrastent neointimal hyperplasia after implantation of ³²P radioactive stents at activities of 0.75 to 12 µCi. Whereas in-stent restenosis was all but obliterated at higher doses of radiation, intralesion restenosis was high because of late lumen loss at the stent edges. Aptly, the authors coined the term "candy wrapper" to describe this new restenotic pattern. It is possible that the animal workers who implanted the first radioactive stents observed this phenomenon. Unfortunately, the significance of this finding may not have been immediately apparent.

Historical and Dosimetric Considerations

The study by Albiero and colleagues reflects the courage of the . . . [Full Text of this Article]

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