CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Mario Togni, MD and
Otto M. Hess, MD*
* University Hospital, CH-3010 Bern, Switzerland (Email: Otto.Hess{at}insel.ch).
Regarding our recent study in JACC (1), we would like to thank Drs. Kipshidze and Leon for the clarifying arguments on the effects of sirolimus and paclitaxel on endothelial cells. We agree that endothelial dysfunction and incomplete vascular healing may play a key role in the development of peristent lesions and late stent thrombosis after drug-eluting stent (DES) implantation, although this link has not been established so far. We can only support the need for inclusion of functional studies before introduction of new DESs in order to identify potential negative effects on endothelial recovery and vascular healing.
The observation by Dr. Wheatcroft and colleagues of life-threatening coronary artery spasm following sirolimus-eluting stent deployment is impressive and underscores the important role of vasomotor function after stent implantation. A recent report demonstrated severe multivessel spasms and aborted sudden cardiac death 10 h after paclitaxel-eluting stent implantation (2). A similar phenomenon has been described after high-dose intracoronary beta-radiation by Scheinert et al. (3), who concluded that vasoconstriction is a frequent finding a few minutes after beta-radiation and may be due to acute radiation-induced endothelial dysfunction.
These two letters underline the key role of re-endothelialization for maintaining a normal vascular function after stent implantation or intracoronary radiotherapy.
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References
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1. Togni M, Windecker S, Cocchia R, et al. Sirolimus-eluting stents associated with paradoxic coronary vasoconstriction J Am Coll Cardiol 2005;46:231-236.[Abstract/Free Full Text]2. Kim JW, Park CG, Seo HS, Oh DJ. Delayed severe multivessel spasm and aborted sudden death afer Taxus stent implantation Heart 2005;91:e15.[Abstract/Free Full Text] 3. Scheinert D, Strnad V, Müller R, et al. High-dose intravascular ß-radiation after de novo stent implantation induces coronary artery spasm Circulation 2002;105:1420-1423.[Abstract/Free Full Text]
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