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CLINICAL STUDIES

Long-term endothelial dysfunction after coronary artery stenting

^a Bayer Inc., Cardiovascular Clinical Research Laboratory, Toronto, Canada
^b Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada

Manuscript received January 15, 1999; revised manuscript received June 14, 1999, accepted August 5, 1999.

Reprint requests and correspondence: Dr. Paulo Caramori, Servicio de Cardiologia, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos 2350, Sala 2050 Porto Alegre, RS 90035.003 Brazil

OBJECTIVES

We assessed the endothelial-dependent vasomotor function in nonrestenotic coronary arteries more than six months following stent implantation, balloon angioplasty (BA), and directional atherectomy (DCA).

BACKGROUND

Catheter-based coronary interventions are associated with extensive arterial injury. Endothelial function has been shown to remain chronically abnormal after vascular injury. The long-term effects of different percutaneous coronary interventions on endothelial function are not known.

METHODS

Thirty-nine patients treated at least six months earlier with a coronary intervention for isolated proximal left anterior descending (LAD) stenosis, with no evidence of restenosis, were studied. Twelve patients had been stented, 15 had been treated with BA, and 12 had undergone DCA. Changes in diameter of the intervened LAD, and the unintervened circumflex coronary artery (Cx), in response to intracoronary acetylcholine infusions were assessed by quantitative angiography.

RESULTS

The groups had similar angiographic characteristics and risk factors for endothelial dysfunction. The LAD constricted significantly more (p = 0.02) in previously stented patients (–21.8 ± 4.3%), as compared to patients previously treated with BA (–9.5 ± 2.8%) or with DCA (–9.1 ± 3.6%). In contrast, acetylcholine infusion resulted in mild constriction in the Cx, which was similar in the three groups (p = 0.47). By multiple regression analysis, previous implant of a stent was the only significant predictor of LAD constriction (p = 0.008).

CONCLUSIONS

More severe endothelial dysfunction was observed long term after stenting as compared to BA or DCA. These findings may have implications with respect to the progression of atherosclerosis in coronary arteries subjected to percutaneous interventions.

Abbreviations and Acronyms   BA = balloon angioplasty   Cx = circumflex coronary artery   DCA = directional atherectomy   LAD = left anterior descending coronary artery

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