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.
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Figure 1 Original recording of the left coronary artery at baseline (left), during exercise with 75 W (middle), and after 1.6 mg of sublingual nitroglycerin (right). The proximal (prox) and the distal segment adjacent to the sirolimus-eluting stent show vasoconstriction by 8% and 14%, respectively, during exercise. After sublingual nitroglycerin, the proximal and distal segment dilate by 26% and 28%, respectively.
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Figure 2 Line chart with individual values for vessel diameter (mm) in the proximal, distal, and stent segment at baseline, during exercise, and after nitroglycerin. The p values for paired comparison are indicated.
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Figure 3 Line chart with percent changes of the mean cross-sectional lumen area in the sirolimus and control groups during exercise (left panel) and after nitroglycerin application (right panel). Mean values ± SEM are shown for the proximal reference segment (Prox.Ref.), the proximal segment (Prox.), the stent segment (Stent), the distal segment (Distal), and the distal reference segment (Distal ref.). The stent segment does not elicit any vasomotion. The sirolimus group shows exercise-induced vasoconstriction of the proximal (–12 ± 4%) and distal (–15 ± 6%) segment to the stent, whereas the control group demonstrates exercise-induced vasodilation of the respective segments (15 ± 3% and 17 ± 4%) (p < 0.001). The proximal and distal reference segments dilate during exercise in both groups. After nitroglycerin application, all the segments (except for the stent) show maximal vasodilation.
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