PubMed · 10569921
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1999. Diagnostic angiography.. https://pubmed.ncbi.nlm.nih.gov/10569921/
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BACKGROUND: Balloon-expandable beta-particle-emitting ((32)P) stents inhibit within-stent neointimal hyperplasia but induce lumen narrowing beyond the stent margins, ie, the so-called "edge effects." METHODS AND RESULTS: We prospectively investigated the performance of novel stents impregnated with the gamma-emitting isotope (103)Pd, designed to reduce edge effects, in 24 rabbits. The stents had a length of 18 mm and were mounted on 20-mm-long delivery balloons for deployment. Angiograms were obtained immediately and 1 month after direct implantation of control and 1-, 2-, and 4-mCi (103)Pd stents into the iliac arteries without predilatation or postdilatation. Late lumen loss was measured with quantitative angiography. Neointimal hyperplasia and vascular remodeling were evaluated by histomorphometry. Late lumen loss was inhibited within (103)Pd stents (control 0.18 mm, 1 mCi 0.08 mm, 2 mCi 0.05 mm, and 4 mCi -0.03 mm, P<0.05 all activities versus control). Conversely, late lumen loss occurred at the edges of (103)Pd stents, correlating with areas of high balloon/artery ratios and vessel overstretch injury. Edge effects were primarily due to neointimal hyperplasia but were also caused by negative vessel remodeling at high stent activities. CONCLUSIONS: Edge effects after implantation of radioisotope stents can occur independently of the isotope chosen for stent impregnation.
Because of the reduced stress on the patient, the obviation of surgical trauma and the need for anesthesia, and only brief hospitalization, stent angioplasty is an attractive alternative to surgical treatment of carotid artery stenosis. The data so far available suggest that the results may be expected to equal those obtained with surgery in terms of success rate and complications. The establishment of the indication for this procedure is oriented to the indication for thromboendarterectomy, with certain patient groups possibly benefitting from endoluminal treatment. However, until data from controlled studies become available, stenting of the carotid artery should be limited to scientific studies and be registered with appropriate professional associations.
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