放射性液体球囊血管内照射防治血管成形术后再狭窄的实验研究Experimental study of endovascular brachytherapy using irradiation liquid filled balloon catheter
王日胜,霍勇,陈明,朱国英
摘要(Abstract):
目的评定放射性液体球囊防治血管成形术后再狭窄的有效性、安全性和可行性,并观察其剂量效应关系,初步探讨其作用机制。方法18只日本大耳白兔髂动脉经球囊过度扩张损伤后,一侧行32P或90Y放射性液体球囊血管内照射作治疗,另一侧以假源(充盈造影剂的液体球囊)未经治疗作对照。5周后重复血管造影观察血管影像学改变;原位固定取材后,分析血管断面组织形态学的变化;免疫组化方法观察增殖细胞核抗原(PCNA)阳性细胞以了解血管壁细胞的增殖情况;行胶原染色显示细胞外基质的合成情况。结果造影可见兔髂动脉经球囊过度扩张损伤后未经治疗的靶血管段明显狭窄,平均狭窄程度达77%;血管壁吸收剂量为24 Gy的靶血管段无明显狭窄或仅轻度狭窄(平均狭窄程度为 12%),16 Gy者为 30%,8 Gy者为76%。兔髂动脉病理切片行 HE染色和弹力纤维染色,经计算机图像分析可见:血管壁吸收剂量为 24 Gy和 16 Gy的靶血管段外弹力板围绕面积,内弹力板围绕面积,新生内膜面积,管腔面积分别与其自身对照相比具有统计学意义(P<0.01);8Gy者与其自身对照血管段相比无统计学意义(P>0.05)。行PCNA染色可见:对照血管段,血管壁吸收剂量为 8 Gy、1?
关键词(KeyWords): 近距离照射;再狭窄;介入治疗
基金项目(Foundation):
作者(Author): 王日胜,霍勇,陈明,朱国英
参考文献(References):
- 1 Klein LW, Rosenblum J. Restenosis after successful percutaneous transluminal coronary angioplasty. Prog Cardiovasc Dis, 1990,32: 365-382.
- 2 Weinberger J, Amols H, Ennis RD, et al. Intracoronary irradiation:Dose response for the prevention of restenosis in swine. Int J RadiatOncol Biol Phys, 1996,36:767-775.
- 3 Mazur W, Ali MN, Khan MM,et al. High dose rate intracoronaryradiation for inhibition of neointimal formation in the stented andballoon-injured models of restenosis: Angiographic,morphometric, andhitopathologic analyses. Int J Radiat Oncol Biol Phys, 1996,36:777-788.
- 4 Teirstein PS, Massullo V, Jani S, et al. Catheter-based radiotherapy toinhibit restenosis after coronary stenting. N Engl J Med, 1997, 336:1697- 1703.
- 5 Waksman R, Porrazzo MS, Chan RC, et al. Results from theARTISTIC feasibility study of 192-iridium gamma radiation to preventrecurrence of in-stent restenosis. Circulation, 1998, 98: 17, I-442:2327.
- 6 Robinson KA, Pipes D, Bibber RV, et al. Dose-response evaluation inballoon-injured pig coronary arteries of a beta-emitting Re liqid-filled balloon catheter system of endovascular brachytherapy. Advances incardiovascular radiation therapy II. March 8-10, 1998: 11.
- 7 Mintz GS, Kovach JA, Pichard AD, et al. Geometric remodeling is thepredominant mechanism of clinical restenosis after coronary angioplasty (Abstract). J Am Coll Cardiol, 1994a,23: 138A.