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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Intense Vasoconstriction in Response to Aspirate From Stented Saphenous Vein Aortocoronary Bypass Grafts

Kirsten Leineweber, PhD^_*, Dirk Böse, MD, Magdalene Vogelsang, MSc^_*, Michael Haude, MD, FACC, Raimund Erbel, MD, FACC and Gerd Heusch, MD, FACC^_*,_*

^_* Institute of Pathophysiology, University of Essen School of Medicine, Essen, Germany
Department of Cardiology, University of Essen School of Medicine, Essen, Germany

Manuscript received March 29, 2005; revised manuscript received September 29, 2005, accepted October 10, 2005.

^_* Reprint requests and correspondence: Prof. Dr.med Dr.h.c. Gerd Heusch, Institute of Pathophysiology, University of Essen Medical School, Hufelandstrasse 55, 45147 Essen, Germany. (Email: gerd.heusch{at}uni-essen.de).

OBJECTIVES: We sought to identify soluble vasoconstrictor substances that are released during stent implantation into saphenous vein aortocoronary bypass grafts.

BACKGROUND: Atherosclerotic saphenous vein aortocoronary bypass grafts are particularly vulnerable to plaque rupture. Protection devices prevent particulate debris from being embolized. Additional soluble vasoconstrictor substances possibly also contribute to impaired microvascular perfusion.

METHODS: Peripheral venous blood (VB) and aspirate (AS) were obtained from 14 patients with a significant stenosis in a saphenous vein graft during stent implantation under protection with a distal balloon occlusion device. In five additional patients, arterial blood (AB) was also taken distal to the stented lesion before intervention. Vasomotor substances in VB, AB, and AS plasma were identified in a bioassay of rat mesenteric arteries with intact (+E) and denuded endothelium (–E). Vasoconstriction was normalized to that induced by potassium chloride depolarization (100%).

RESULTS: Venous blood, AB, and AS plasma induced maximum vasoconstriction within six minutes. The AS plasma induced a vasoconstriction of 138 ± 13% (–E) and 87 ± 14% (+E); VB, of 70 ± 14% (–E) and 23 ± 4% (+E); and AB plasma obtained before intervention, of 49 ± 9% (–E) and 36 ± 8% (+E). The vasoconstrictor potency of AS plasma in endothelium-denuded vessels was related to the severity of anginal symptoms, angiographic stenosis severity, plaque volume, and plaque burden as determined by intravascular ultrasound. The AS plasma-induced vasoconstriction was largely attenuated by combined serotonin/5-hydroxytryptamine (5-HT)_2A/2C- and 5-HT_1A/1B-receptor blockade and eliminated by additional thromboxane A2 thromboxane-prostanoid (TP)-receptor blockade.

CONCLUSIONS: Stent implantation releases, apart from and in addition to particulate debris, soluble vasoconstrictor substances that possibly contribute to impaired microvascular perfusion.

Abbreviations and Acronyms   5-HT = 5-hydroxytryptamine   AB = arterial blood   AS = aspirate   IVUS = intravascular ultrasound   VB = venous blood

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