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Related Experiment Videos

Acute vasculitis after endovascular brachytherapy.

Luis F Fajardo L-G1, Stavros D Prionas, Grzegorz L Kaluza

  • 1Pathology and Laboratory Medicine Service (113), Stanford University and Veterans Affairs Medical Center, 3801 Miranda Avenue, Palo Alto, CA 94304, USA.

International Journal of Radiation Oncology, Biology, Physics
|June 14, 2002
PubMed
Summary

Endovascular brachytherapy using 32P radiation can cause necrotizing vasculitis in nearby arterioles, a previously unrecognized lesion. This radiation-associated vasculitis may lead to ischemia in humans and requires further study to understand its mechanism.

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Area of Science:

  • Cardiovascular Research
  • Radiation Oncology
  • Vascular Biology

Background:

  • Coronary artery stenosis is effectively treated with angioplasty, but restenosis remains a challenge.
  • Endovascular radiation therapy (brachytherapy) is used to prevent restenosis after angioplasty in humans and swine.
  • Limited data exists on the effects of endovascular radiation beyond the target coronary artery wall.

Purpose of the Study:

  • To investigate the effects of endovascular radiation exposure on tissues surrounding coronary arteries.
  • To identify potential lesions or adverse effects resulting from endovascular brachytherapy.

Main Methods:

  • Samples from 76 minipigs with irradiated coronary and iliac arteries (using 32P sources, 35 Gy) were examined at 28 days and 6 months.
  • Vessels underwent angioplasty or stenting in two-thirds of cases.

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  • Histopathological analysis focused on arterioles within 2.05 mm of the target artery.

    • Main Results:

    • An unexpected finding was acute necrotizing vasculitis in arterioles near the irradiated arteries.
    • This vasculitis, characterized by fibrinoid necrosis and thrombosis, occurred in 51% of coronary and 100% of iliac arteries at 28 days.
    • By 6 months, acute vasculitis decreased, but healing vasculitis with luminal narrowing was observed in 46% of samples; it was not seen in unirradiated vessels.

    Conclusions:

    • Endoarterial brachytherapy with 32P induces vascular effects beyond the target vessel, including necrotizing vasculitis in adjacent arterioles.
    • The mechanism of this radiation-associated vasculitis is unclear, with no evident dose-response relationship.
    • This lesion, potentially occurring around human coronary arteries, may lead to ischemia and has not been previously recognized.