Effects of intraluminal irradiation with Holmium-166 for TIPS stenosis: experimental study in a swine model.
OBJECTIVE
We wanted to evaluate the effectiveness of intraluminal irradiation with Holmium-166 ((166)Ho) for reducing the pseudointimal hyperplasia (PIH) in the transjugular intrahepatic portosystemic shunt (TIPS) tract in a swine model.


METHODS
TIPS was performed in 12 domestic pigs, after the creation of portal hypertension by intraportal injection of a mixture of N-butyl-2-cyanoacrylate (NBCA) and lipiodol. Five pigs first underwent intraluminal irradiation (30 Gy) in the parenchymal tract with using a (166)Ho solution-filled balloon catheter, and this was followed by the placement of a nitinol stent in the TIPS tract. For the seven control pigs, the balloon was filled with saline and contrast media mixture. Two weeks later, follow-up portography and histological analysis were performed.


RESULTS
TIPS was successfully performed in all twelve pigs with achieving artificially induced portal hypertension. Portography performed two weeks after TIPS showed the patent tracts in the TIPS tracts that were irradiated with (166)Ho (5/5, 100%), whereas either completely (5/6, 83.3%) or partially (1/6, 16.7%) occluded TIPS were seen in the seven pigs of the nonirradiated control group, except in one pig that experienced periprocedural death due to bleeding. Histological analysis showed a statistically significant difference for the maximal PIH (irradiated: 32.8%, nonirradiated: 76.0%, p < 0.001) between the two groups.


CONCLUSIONS
Intraluminal irradiation with 30 Gy of (166)Ho for TIPS significantly improved the TIPS patency in a swine model of portal hypertension during a 2-week period of follow-up.
Park
Ji Seon
JS
Department of Diagnostic Radiology, Kyung Hee University Medical Center, Dongdaemun-Gu, Seoul, Korea.
Oh
Joo Hyeong
JH
Kim
Deog Yoon
DY
Park
Yong Koo
YK
Park
Sang Joon
SJ
Kim
Soo Joong
SJ
D000497:Alloys; D000818:Animals; D003251:Constriction, Pathologic / Q000532:radiotherapy*; D006695:Holmium / Q000627:therapeutic use*; D006975:Hypertension, Portal / Q000628:therapy; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011868:Radioisotopes / Q000627:therapeutic use*; D015607:Stents; D013552:Swine
D000497:Alloys; D011868:Radioisotopes; C013616:nitinol; D006695:Holmium