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(Stroke. 2006;37:2147.)
© 2006 American Heart Association, Inc.

Original Contributions

Safety and Effectiveness of Radioactive Coil Embolization of Aneurysms

Effects of Radiation on Recanalization, Clot Organization, Neointima Formation, and Surrounding Nerves in Experimental Models

Jean Raymond, MD; Charbel Mounayer, MD; Igor Salazkin, MD; Annick Metcalfe, MSc; Guylaine Gevry, BSc; Christian Janicki, PhD; Sjoerd Roorda, PhD Philippe Leblanc, PhD

From the CHUM Notre Dame Hospital Research Centre (J.R., I.S., A.M., G.G., P.L.), Montreal, Canada; Service de Neuroradiologie Interventionnelle (C.M.), Hôpital de la Fondation Rothschild, Paris, France; the Department of Medical Physics, McGill University Health Centre (C.J.), Montreal, Canada; and the Department of Physics (S.R.), University of Montreal, Montreal, Canada.

Correspondence to Jean Raymond, MD, Centre hospitalier de l’Université de Montréal (CHUM)—Hôpital Notre Dame, Interventional Neuroradiology Research laboratory, 1560 Sherbrooke E, Suite M-8203, Montreal, Quebec, Canada H2L 4M1. E-mail dr_jean_raymond{at}hotmail.com

Background and Purpose— Recanalization after coil embolization can be prevented by radiation emitted from ³²P coils. We wanted to determine the upper limits of ³²P activities that could be implanted onto coils with respect to the potential injury to nearby nerves, delay in organization of the clot, and effects on neointima formation and recanalization.

Methods— We studied the effects of various ³²P activities on recanalization and organization of thrombus after coil occlusion of canine arteries and on neointima formation at the neck of canine carotid bifurcation aneurysms. We also tested potential injury to nerves in the vicinity of radioactive or nonradioactive coils in 3 models: the brachial plexus (near proximal vertebral arteries) and the lingual nerve in a lingual artery bifurcation aneurysm model, both models being treated by radioactive or standard coil occlusion. Finally, we wrapped lingual nerves with nonradioactive or high-activity coils and studied their effects on lingual nerves and tongues. Results were assessed with a pathological scoring system and compared with Mann-Whitney and Kruskal-Wallis tests.

Results— No deleterious effect of radiation on nerves could be detected. Neointima formation was not hampered, scores of aneurysms treated with ³²P-coils being significantly better when compared with treatments with standard coils (P=0.002). Arteries treated with high-activity coils (>3.39 µCi) showed absent recanalization but delayed organization of the clot at 3 months compared with low-activity or nonradioactive coils (P<0.05).

Conclusions— ß-Radiation can prevent recanalization after coil occlusion. We could not demonstrate any deleterious effects of radioactivity on nervous structure or on neointima formation. Delayed organization of thrombus provides a rational basis to establish an upper limit for ³²P activities to be implanted onto coils.

Key Words: animal models • nerve degeneration • radiation • recanalization

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