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J Am Coll Cardiol, 2005; 46:231-236, doi:10.1016/j.jacc.2005.01.062 (Published online 5 July 2005).
© 2005 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Sirolimus-Eluting Stents Associated With Paradoxic Coronary Vasoconstriction

Mario Togni, MD, Stephan Windecker, MD, Rosangela Cocchia, MD, Peter Wenaweser, MD, Stephane Cook, MD, Michael Billinger, MD, Bernhard Meier, MD, FACC and Otto M. Hess, MD, FACC*

Swiss Cardiovascular Center Bern, Bern, Switzerland.

Manuscript received October 11, 2004; revised manuscript received December 27, 2004, accepted January 11, 2005.

* Reprint requests and correspondence: Dr. Otto M. Hess, Professor of Cardiology, Swiss Cardiovascular Center, Inselspital, CH-3010 Bern, Switzerland. (Email: otto.hess{at}insel.ch).

OBJECTIVES: The purpose of the present study was to assess coronary vasomotor response to exercise after sirolimus-eluting stent (SES) implantation.

BACKGROUND: Sirolimus-eluting stents have been shown to markedly reduce the incidence of angiographic and clinical restenosis. However, long-term effects of sirolimus on endothelial function are unknown.

METHODS: Coronary vasomotion was evaluated with biplane quantitative coronary angiography at rest and during supine bicycle exercise in 25 patients with coronary artery disease. Eleven patients were treated with a bare-metal stent (BMS) (control group) and 14 patients underwent SES implantation (sirolimus group) for de novo coronary artery lesions. Both groups were studied 6 ± 1 month after the intervention. Minimal luminal diameter; stent diameter; and proximal, distal, and reference vessel diameter were determined.

RESULTS: The reference vessel showed exercise-induced vasodilation (+13 ± 4%) in both groups. Vasomotion within the stented vessel segments was abolished. In controls, the adjacent segments proximal and distal to the stent showed exercise-induced vasodilation (+15 ± 3% and +17 ± 4%, respectively). In contrast, there was exercise-induced vasoconstriction of the proximal and distal vessel segments adjacent to SESs (–12 ± 4% and –15 ± 6%, respectively; p < 0.001 vs. corresponding segments of controls). Sublingual nitroglycerin was associated with maximal vasodilation of the proximal and distal vessel segments in both groups.

CONCLUSIONS: Implantation of a BMS does not affect physiologic response to exercise proximal and distal to the stent. However, SESs are associated with exercise-induced paradoxic coronary vasoconstriction of the adjacent vessel segments, although vasodilatory response to nitroglycerin is maintained. These observations suggest (drug-induced) endothelial dysfunction as the underlying mechanism.

Abbreviations and Acronyms
  BMS = bare-metal stent
  NO = nitric oxide
  NTG = nitroglycerin
  SES = sirolimus-eluting stent




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