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(Circulation. 2001;104:2388.)
© 2001 American Heart Association, Inc.

Editorials

Intracoronary Brachytherapy in the Porcine Model

A Different Animal

Tim A. Fischell, MD; Renu Virmani, MD

From the Heart Institute at Borgess Medical Center, Kalamazoo, Mich (T.A.F.), and the Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC (R.V.).

Correspondence to Renu Virmani, MD, Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, 6825, 16th Street NW, Washington, DC 20306-6000. E-mail virmani@afip.osd.mil

Key Words: Editorials • catheters • balloon • brachytherapy

Since the introduction of percutaneous coronary balloon angioplasty, restenosis has remained the most challenging problem facing interventional cardiologists. Stenting has reduced the need for clinically driven repeat revascularization, but has far from eliminated it. As early as 1989, intravascular brachytherapy was proposed as a means to ameliorate the proliferative component of restenosis after angioplasty. After promising results in early animal studies, brachytherapy was introduced as a treatment for the prevention of restenosis in clinical trials.^1,2 This treatment was directed primarily at the very challenging subgroup of patients with in-stent restenosis.

See p 2459

In the present issue of Circulation Coussement et al³ describe an unfavorable 6-month outcome after catheter-based ß-irradiation in a porcine coronary model. The results described may provide some insights into the biology of restenosis inhibition with brachytherapy, or they may be a finding limited by the idiosyncrasies of this particular animal model and not directly relevant to humans. In this study, normal pig coronary arteries exposed to 20 or 30 Gy of ß-irradiation delivered by a ¹⁸⁶Re-liquid filled balloon after overdistension balloon injury demonstrated greater neointimal areas and thrombosis at 6 months compared with nonirradiated vessels. On the basis of the discrepancy between the 6-month outcomes in clinical trials and these animal data, the investigators have proposed that the "direct extrapolation of the long-term outcome of endovascular irradiation in the pig coronary artery preparation of restenosis to the human setting is not appropriate."

Before we cast aside the utility of the various animal models of restenosis, we . . . [Full Text of this Article]

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