Indication of long-term endothelial dysfunction after sirolimus-eluting stent implantation.
OBJECTIVE
Endothelial dysfunction has been related both to progression of atherosclerotic disease and to future cardiovascular events. We assessed local epicardial endothelial function 6 months after sirolimus-eluting stent (SES) or bare metal stent (BS) implantation.


RESULTS
In 12 patients (seven SES, five BS), endothelium-dependent vasomotion of a coronary segment 15 mm in length, starting 2 mm distal to the stent, was assessed with quantitative coronary angiography immediately after the procedure and at 6 months follow-up, after intracoronary infusion of acetylcholine. Intravascular ultrasound (IVUS) was performed and coronary flow reserve (CFR) assessed in all patients. At follow-up significant vasoconstriction was seen in SES (median 32% diameter reduction from baseline) but not in BS (median 2% reduction) patients after acetylcholine infusion (P=0.03 for SES vs. BS); endothelium-independent vasodilatation to nitrates did not differ significantly between groups (20% SES, 5% BS, P=0.14). IVUS revealed no late unhealed dissections and CFR was comparable between groups (SES 3.1 vs. BS 3.2, n.s.).


CONCLUSIONS
SES implantation may have an adverse effect on local endothelium-dependent vasomotor responses compared with BS implantation at 6 months. Long-term clinical consequences of this observation are still unknown.
Hofma
Sjoerd H
SH
Department of Cardiology, Thoraxcenter, Erasmus MC, Bd 412, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
van der Giessen
Wim J
WJ
van Dalen
Bas M
BM
Lemos
Pedro A
PA
McFadden
Eugene P
EP
Sianos
Georgios
G
Ligthart
Jurgen M R
JM
van Essen
Dirk
D
de Feyter
Pim J
PJ
Serruys
Patrick W
PW
D000368:Aged; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000517:prevention & control*; D003329:Coronary Vasospasm / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003925:Diabetic Angiopathies / Q000150:complications; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000187:drug effects*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000494:pharmacology; D011446:Prospective Studies; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents / Q000009:adverse effects; D014664:Vasodilation / Q000187:drug effects; D014665:Vasodilator Agents / Q000494:pharmacology
D007166:Immunosuppressive Agents; D014665:Vasodilator Agents; D005996:Nitroglycerin; D020123:Sirolimus