以球囊携带液体^(188)铼兔颈动脉腔内照射预防再狭窄的实验研究

β-Irradiation with a liquid ^(188)Re-filled balloon prevents neointimal proliferation in the carotid rabbit

目的 评价以球囊携带液体1 88铼 (1 88Re)兔颈动脉腔内照射预防再狭窄的可行性及作用。方法 12只兔颈动脉过大球囊损伤内膜后行1 88Re放射治疗 ,随机分为对照组 (n =6 )和照射组(n =6 ) ,管腔下 0 0 5mm处的吸收剂量为 15Gy。全部兔饲养 1周后活杀 ,取病理组织学标本进行分析。结果 照射组内膜面积明显小于对照组 [(0 0 4± 0 0 6 )mm2 vs (0 16± 0 0 4)mm2 ,P <0 0 5 ],管腔面积明显大于对照组 [(0 6 5± 0 0 5 )mm2 vs (0 35± 0 0 3)mm2 ,P <0 0 5 ],血管面积大于对照组[(1 0 4± 0 2 3)mm2 vs (0 81± 0 0 5 )mm2 ,P =0 0 4]。照射中央区管腔面积大于边缘区 [(0 6 5± 0 0 5 )mm2 vs(0 2 5± 0 0 6 )mm2 ,P <0 0 5 ],内膜面积小于边缘区 [(0 0 4± 0 0 6 )mm2 vs(0 12± 0 10 )mm2 ,P<0 0 5 ],内弹力板面积大于边缘区 [(0 70± 0 0 4)mm2 vs(0 37± 0 14)mm2 ,P =0 0 6 ],血管面积大于边缘区 [(1 0 4± 0 2 4)mm2 vs (0 6 3± 0 17)mm2 ,P <0 0 5 ]。结论 以球囊携带液体1 88Re血管腔内照射通过抑制内膜增生及血管重塑来减少再狭窄 ;边缘效应主要是由于血管的收缩性重塑引起的。

Objective To evaluate the role of β-irradiation with a liquid 188Re-filled balloon for limiting neointimal proliferation. Methods Balloon overstretch injury was performed in carotid arteries of 12 rabbits and randomly assigned to two groups: the control group (n=6) and the radiation group (n=6), using the liquid 188Re-filled balloon designed to deliver 15 Gy at 0.5 mm from the surface of vessel. All animals survived and were sacrificed in 1 week. Histopathologic analysis was performed. Results The intimal area of radiation group was significantly smaller than that of the control group [(0.04±0.06) mm 2 vs (0.16±0.04) mm 2, P<0.05]; the lumen area is larger than that of the control [(0.65±0.05) mm 2 vs (0.35±0.03) mm 2, P<0.05]; the vessel area was larger [(1.04±0.23) mm 2 vs (0.81±0.05) mm 2,P=0.04]. The lumen area of middle region was larger than that of side region [(0.65±0.05))mm 2 vs (0.25±0.06)mm 2, P<0.05], the intimal area was smaller than side region [(0.04±0.06)mm 2 vs (0.12±0.10)mm 2, P<0.05], and surrounding internal elastic area (IEA) larger [(0.70±0.04)mm 2 vs (0.37±0.14)mm 2, P=0.06], the vessel area was larger [(1.04±0.24)mm 2 vs (0.63±0.17)mm 2, P<0.05]. Conclusion β-irradiation with a liquid 188Re-filled balloon decreased restenosis by inhibiting the neointima and remodeling. The side effect was most induced by constrictive remodeling.