• Title/Summary/Keyword: Restenosis

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Dosimetry and MIRD for Re-188 Liquid Balloons (Re-188-DTPA 풍선 주위 선량분포와 의용내부피폭선량)

  • Lee, Dong-Soo;Lee, Jin
    • 대한핵의학회:학술대회논문집
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    • 1999.05a
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    • pp.222-227
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    • 1999
  • Re-188 is suitable for endovascular liquid-balloon brachytherapy for the prevention of restenosis after angioplasty. Re-188 was concentrated to 3700 MBq/ml and labeled with DTPA. According to dosimetric calculation, it took 420 seconds using Re-188 solution with concentration of 3700 MBq/ml to irradiate 17.6 Gy to the target at 1 mm from the balloon surface. Software was made to estimate the irradiation time. MIRD calculation with dynamic bladder model yielded the whole body dose of Re-188-DTPA as 0.005 mGy/MBq in case of balloon rupture and release of the whole amount into the blood.

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Reconstruction of the Cervical Esophagus Using the Free Jejunal Graft (경부 식도협착 재건술에 있어서 유리공장 이식편의 이용)

  • 지청현
    • Journal of Chest Surgery
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    • v.24 no.12
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    • pp.1232-1237
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    • 1991
  • The cervical esophageal stricture has various surgical modalities and difficulties in reconstruction. We had experienced a case of successful reconstruction of the cervical esophageal restenosis using the free jejunal graft, on 30 year old man had had esophageal stricture after ingestion of lye. He had undergone colon interposition[esophagocologastrostomy] with left colon feeding gastrostomy. But restenosis was occurred just above of the cervical esophagocolostomy site several times of balloon dilatation were failed. So, we decided to use of the free jejunal graft. The free jejunal graft was isolated about 15cm length with it`s vascular arcades. The graft was irrigated with the mixed solution as isotonic saline, heparin and papaverine chloride. The artery of graft was anastomosed to the branch of the external carotid artery in end to side with continuous sutures of the 8.0 Prolene. The vein of the graft was anastomosed to the branch of the anterior facial vein in end to end with continuous sutures of the 8.0 prolene. Postoperative course was uneventful and the patient was discharged after removal of the tracheostomy cannula and gastrostomy tube.

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A Novel Deposition Method of PLGA Nanoparticles on Coronary Stents

  • Joo, Jae-Ryang;Nam, Hye-Yeong;Nam, So-Hee;Baek, In-Su;Pakr, Jong-Sang
    • Bulletin of the Korean Chemical Society
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    • v.30 no.5
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    • pp.1085-1087
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    • 2009
  • Bare metal stents which were used to treat coronary artery disease have several biochemical problems. Polymerbased drug-eluting stents (DES) have opened up a new paradigm in the treatment of in-stent restenosis. Many studies and research programmes have proved that DES can prevent restenosis. In our study, paclitaxel-loaded poly (lactic-co-glycolic acid) (PLGA) nanoparticles have been deposited along the three dimensional scaffold of coronary stents by a method using self-assembling properties of colloidal particles. We found that the nanoparticles were deposited uniformly and closely packed. The amount of paclitaxel was easily controlled by the drug content of the nanoparticles and the deposition count.

Radioisotope Treatment for Benign Strictures of Non-vascular Luminal Organs (비혈관성 관강 장기의 양성 협착 질환의 방사성동위원소 치료)

  • Shin, Ji-Hoon
    • Nuclear Medicine and Molecular Imaging
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    • v.40 no.2
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    • pp.106-112
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    • 2006
  • Tissue hyperplasia is one of the most frequently encountered complications when self-expanding metallic stents are placed in benign non-vascular luminal organ strictures, thus causing restenosis of the lumen. The investigators postulated that ionizing irradiation could be applied to prevent restenosis caused by tissue hyperplasia in non-vascular luminal organs as it reduced coronary or peripheral arterial narrowing successfully. The authors combined $\beta$-irradiation using $^{188}Re-MAG_3$ solution with balloon dilation for animal and clinical studies because this new treatment approach had the advantages such as low penetration depth of $\beta$-ray, self-centering irradiation, and mechanical effect of balloon dilation over using $\gamma$-irradiation with afterloading devices in this article, the concept and mechanism of radioisotope balloon dilation, and animal and clinical studies using radioisotope balloon dilation are reviewed.

Neurotoxicity of Paclitaxel and Rapamycin in a Rat Model with Transient Blood-Brain Barrier Opening

  • Cho, Won-Sang;Choi, Jung Hoon;Kwon, O-Ki
    • Journal of Korean Neurosurgical Society
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    • v.65 no.2
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    • pp.180-185
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    • 2022
  • Objective : Drug-eluting stents and balloons are occasionally used to reduce restenosis in medically intractable intracranial atherosclerotic stenosis. The authors aimed to determine whether such drugs can cause neurotoxicity due to local effects in a rat model. Methods : Intra-arterial catheters were placed in the right common carotid artery of rats. Mannitol was injected to transiently open the brain-blood barrier (BBB), followed by high-dose drug (paclitaxel and rapamycin) injection. The optimal time interval of transient BBB opening for maximal drug penetration was determined to be 10 minutes. Paclitaxel and rapamycin were intra-arterially administered in various doses. All the rats were neurologically evaluated, and their brain tissues were histologically examined. Results : Neither neurological deficits nor histological abnormalities were observed in all the rats. Conclusion : Paclitaxel and rapamycin did not cause neurotoxicity in a rat model with transient BBB opening.

Surgical Treatment of Bronchial Restenosis Occuring After Insertion of Self-Expandable Metalic Stent in Patients with Bronchial Stenosis -2 Cases Reports- (기관지협착환자에서 기관지내 팽창성 급속 스텐트 삽입후 재발한 기관지협착 치험 2례)

  • Kim, Woo-Chan;Jin, Ung;Rha, Suk-Joo;Jo, Keon-Hyon;Lee, Sun-Hee;Kwack, Moon-Sub;Kim, Se-Wha
    • Journal of Chest Surgery
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    • v.28 no.5
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    • pp.499-503
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    • 1995
  • Since the insertion of self expandable metalic stent[SEMS has became popular method for hollow organ stenosis, many attempts for further apply the stent to airway stenosis as an simple procedure has been made, but intrabronchial migration of stent or occurrence of inflammatory granuloma around stent develop occasionally and sometimes it worsen bronchial stenosis further more. This report describes 2 case of surgically treated bronchial restenosis in whom intrabronchial stent were applied for release of bronchial stenosis. Our surgical option was pneumonectomy and bronchoplasty with sleeve right middle and upper lobectomy respectively. During the operation we found the SEMSs were tightly impacted in restenotic bronchial lumen with overgrowth of granulation tissues. The bronchial obstructions occupied more than 90% of lumens in both cases, and needed much complicated procedure to be relieved. Therefore, even though the insertion of SEMS remains as a prcedure determined by the physician`s preference, it has to be considered prudently that the use of SEMS can cause severe restenosis and the surgeon has more difficulties in performing segmental resection of restenotic bronchus in patient with SEMS previously inserted. Throughout these experiences we can conclude that the insertion of SEMS must be performed only in very selected cases of bronchial stenosis.

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Hemodynamic Characteristics Affecting Restenosis after Percutaneous Transluminal Coronary Angioplasty with Stenting in the Angulated Coronary Stenosis

  • Lee, Byoung-Kwon;Kwon, Hyuck-Moon;Roh, Hyung-Woon;Cho, Min-Tae;Suh, Sang-Ho
    • International Journal of Vascular Biomedical Engineering
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    • v.1 no.1
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    • pp.13-23
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    • 2003
  • Backgrounds: The present study in angulated coronary stenosis was to evaluate the influence of velocity and wall shear stress (WSS) on coronary atherosclerosis, the changes of hemodynamic indices following coronary stenting, as well as their effect of evolving in-stent restenosis using human in vivo hemodynamic parameters and computed simulation quantitatively and qualitatively. Methods: Initial and follow-up coronary angiographies in the patients with angulated coronary stenosis were performed (n=80). Optimal coronary stenting in angulated coronary stenosis had two models: < 50 % angle changed(model 1, n=43), > 50% angle changed group (model 2, n=37) according to percent change of vascular angle between pre- and post-intracoronary stenting. Flow-velocity wave obtained from in vivo intracoronary Doppler study data was used for in vitro numerical simulation. Spatial and temporal patterns of velocity vector and recirculation area were drawn throughout the selected segment of coronary models. WSS of pre/post-intracoronary stenting were calculated from three-dimensional computer simulation. Results: Follow-up coronary angiogram demonstrated significant difference in the percent of diameter stenosis between two groups (group 1: $40.3{\pm}30.2$ vs. group 2: $25.5{\pm}22.5%$, p<0.05). Negative WSS area on 3D simulation, which is consistent with re-circulation area of velocity vector, was noted on the inner wall of post-stenotic area before stenting. The negative WSS was disappeared after stenting. High spatial and temporal WSS before stenting fell into within physiologic WSS after stenting. This finding was prominent in Model 2 (p<0.01) Conclusions: The present study suggests that hemodynamic forces exerted by pulsatile coronary circulation termed as WSS might affect on the evolution of atherosclerosis within the angulated vascular curvature. Moreover, geometric change, such as angular difference between pre / post-intracoronary stenting might give proper information of optimal hemodynamic charateristics for vascular repair after stenting.

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A Novel Urotensin II Receptor Antagonist, KR-36996 Inhibits Smooth Muscle Proliferation through ERK/ROS Pathway

  • Kim, Tae-Ho;Lee, Dong Gil;Kim, Young-Ae;Lee, Byung Ho;Yi, Kyu Yang;Jung, Yi-Sook
    • Biomolecules & Therapeutics
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    • v.25 no.3
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    • pp.308-314
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    • 2017
  • Urotensin II (UII) is a mitogenic and hypertrophic agent that can induce the proliferation of vascular cells. UII inhibition has been considered as beneficial strategy for atherosclerosis and restenosis. However, currently there is no therapeutics clinically available for atherosclerosis or restenosis. In this study, we evaluated the effects of a newly synthesized UII receptor (UT) antagonist, KR-36996, on the proliferation of SMCs in vitro and neointima formation in vivo in comparison with GSK-1440115, a known potent UT antagonist. In primary human aortic SMCs (HASMCs), UII (50 nM) induced proliferation was significantly inhibited by KR-36996 at 1, 10, and 100 nM which showed greater potency ($IC_{50}$: 3.5 nM) than GSK-1440115 ($IC_{50}$: 82.3 nM). UII-induced proliferation of HASMC cells was inhibited by U0126, an ERK1/2 inhibitor, but not by SP600125 (inhibitor of JNK) or SB202190 (inhibitor of p38 MAPK). UII increased the phosphorylation level of ERK1/2. Such increase was significantly inhibited by KR-36996. UII-induced proliferation was also inhibited by trolox, a scavenger for reactive oxygen species (ROS). UII-induced ROS generation was also decreased by KR-36996 treatment. In a carotid artery ligation mouse model, intimal thickening was dramatically suppressed by oral treatment with KR-36996 (30 mg/kg) which showed better efficacy than GSK-1440115. These results suggest that KR-36996 is a better candidate than GSK-1440115 in preventing vascular proliferation in the pathogenesis of atherosclerosis and restenosis.

Dosimetry and Medical Internal Radiation Dose of Re-188-DTPA for Endovascular Balloon Brachytherapy Against Restenosis after Coronary Angioplasty (혈관성형술 후 재협착 방지 치료에 사용하기 위한 원통형 풍선 Re-188-DTPA의 선량 분포와 내부피폭 선량)

  • Lee, Jin;Lee, Dong-Soo;Shin, Seung-Ae;Jeong, Jae-Min;Chung, June-Key;Lee, Myung-Chul
    • The Korean Journal of Nuclear Medicine
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    • v.33 no.2
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    • pp.163-171
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    • 1999
  • Purpose: Liquid beta emitter filled in angioplasty balloon could be used to perform endovascular balloon brachytherapy to prevent coronary artery restenosis. We investigated the dosimetry for Re-188-DTPA liquid-filled balloon and medical internal radiation dosimetry in case of balloon leakage. Materials and Methods: We estimated radiation dose from an angioplasty balloon (20 mm length, 3 mm diameter cylinder) to the adjacent vessel wall using Monte Carlo EGS4 code. We obtained time-activity curves of kidneys in normal dog and calculated $T_{max},\;T_{1/2}$. Using MIRDOSE3 program, we estimated absorbed doses to the major organs (kidneys, bladder) and the whole body when we assumed that balloon leaked all the isotope contained. Results: The radiation dose was 17.5 Gy at the balloon surface when we applied 3,700 MBq/ml of Re-188 for 100 seconds, Fifty percent of the energy deposited within 1 mm from the balloon surface. The estimated internal dose to the whole body was 0.005 mGy/MBq and 18.5 mGy for the spillage of 3,700 MBq of Re-188. Conclusion: We suggest that Re-188-DTPA can be used for endovascular balloon brachytherapy to inhibit coronary artery restenosis after angioplasty with tolerable whole body radiation dose in case of balloon rupture.

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