Severe, diffuse coronary artery spasm after drug-eluting stent placement.
OBJECTIVE
Three cases of severe, diffuse coronary artery spasm after drug-eluting stent placement at our institution prompted this review.


BACKGROUND
Drug-eluting stents have gained widespread use due to extraordinarily low rates of restenosis. Despite these generally superior clinical outcomes, the specter of rare idiosyncratic reactions remains a concern.


METHODS
We performed searches of Medline and the U.S. FDA Manufacturer And User facility Device Experience database (MAUDE) to identify and describe spasm after coronary stent placement. Searches included drug-eluting and bare-metal stents. Institutional cases are reviewed. Location, time course and outcome of cases are described.


RESULTS
Thirteen cases of spasm were identified after stent placement. Seven cases occurred after Cypher drug-eluting stent placement, 2 after Taxus drug-eluting stent placement, 1 after BiodivYsio and 3 after bare-metal stents. Five patients experienced diffuse, multivessel spasm--2 after Cypher, 2 after Taxus, and 1 after a Velocity stent. Of these 5 patients, 2 died. An additional 2 required intra-aortic balloon pump placement for cardiogenic shock. Another had persistent symptomatic, diffuse coronary spasm documented by angiography at 1 year.


CONCLUSIONS
We describe coronary spasm after stent placement, particularly after drug-eluting stents. Outcomes associated with diffuse severe spasm after stenting are poor, and the pathophysiology remains poorly understood.
Brott
Brigitta C
BC
The University of Alabama at Birmingham, Interventional Cardiology, BDB 383, 1808 7th Avenue South, Birmingham, AL 35294, USA. bbrott@uab.edu
Anayiotos
Andreas S
AS
Chapman
Gregory D
GD
Anderson
Peter G
PG
Hillegass
William B
WB
D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D003329:Coronary Vasospasm / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012720:Severity of Illness Index; D015607:Stents
D007166:Immunosuppressive Agents