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Eur J Cardiothorac Surg 2006;29:334-342
© 2006 Elsevier Science NL

Adjunct brachytherapy: a new concept to prevent intimal hyperplasia after surgical endarterectomy?

^a Department of Cardiac Surgery, University of Heidelberg, INF 110, 69120 Heidelberg, Germany
^b Department of Clinical Radiology, University of Heidelberg, Germany
^c Department of Pathology, University of Heidelberg, Germany

Received 28 July 2005; received in revised form 28 November 2005; accepted 5 December 2005.

^_* Corresponding author. Tel.: +49 6221 566246; fax: +49 6221 564571. (Email: Carsten.Beller{at}urz.uni-heidelberg.de).

Objective: Endarterectomy represents a therapeutical option for patients with advanced coronary artery disease. The mid-term results are compromised by restenosis due to neointima formation. The aim of this study was to evaluate a new treatment concept – endarterectomy with consecutive gamma-irradiation – in a rat model. Methods: Male Sprague–Dawley rats underwent left carotid endarterectomy with removal of intima: control (n = 10) or were irradiated with 15 Gray (Gy) (n = 13) or 20 Gy (n = 10) postoperatively and compared with sham-operated rats (n = 10). After 3 weeks, carotid arteries were perfusion-fixed and vessel compartment areas were measured. Transmission electron microscopy and immunohistochemical staining were used to confirm neointima formation. Results: Three weeks after endarterectomy, neointimal hyperplasia was found in the control group (0.07 ± 0.04 mm²). After irradiation, a dose-dependent reduction of neointima was observed (0.003 mm² at 15 Gy and 0.0007 mm² at 20 Gy, P < 0.0001). However, immunohistochemical staining revealed that thin re-endothelialization after irradiation was not inhibited. Conclusions: Gamma-irradiation significantly suppressed neointimal hyperplasia in a rat model of surgical endarterectomy. Despite inhibition of intimal hyperplasia, re-endothelialization after adjuvant brachytherapy was present. Adjuvant brachytherapy may be therefore a new concept to prevent restenosis after endarterectomy in patients.

Key Words: Endarterectomy • Brachytherapy • Neointima • Restenosis