Differential effects of drug-eluting stents on local endothelium-dependent coronary vasomotion.
OBJECTIVE
The aim of our study was to compare coronary vasomotion after implantation of a second-generation biolimus A9-eluting stent (BES) and of a sirolimus-eluting stent (SES).


BACKGROUND
Drug-eluting stents (DES) have been associated with impaired local coronary vasomotion, delayed endothelialization, and increased late thrombotic risk. New DES with different drugs, pharmacokinetics, and polymers have been developed.


METHODS
Nineteen patients with a BES and 15 patients with a SES were studied 9 months after stent implantation. Endothelium-dependent and -independent coronary vasomotion were tested proximally and distally to the stent as well as at a reference segment during right atrial pacing at increasing heart rates. Quantitative coronary angiographic measurements were performed offline.


RESULTS
Of the patients with BES, 2 showed vasoconstriction with increased heart rate and 17 showed vasodilatation. Of the patients with a SES, 9 showed vasoconstriction while 6 showed vasodilatation. The SES showed significant vasoconstriction at both the proximal (-2.3 +/- 10% vs. 7.9 +/- 10%) and the distal (-5.4 +/- 9% vs. 6.1 +/- 8%) segments to the stent compared with the BES (p = 0.003 for proximal, p < 0.001 for distal segment). Endothelium-independent vasomotion after intracoronary nitrates did not differ significantly between the 2 groups (p = NS for proximal and distal segment).


CONCLUSIONS
Unlike the case with the SES, endothelium-dependent vasomotion at adjacent stent segments seems to be preserved after BES implantation. This result may be explained by the different drug release kinetics, DES design, or characteristics of polymer used in the stent system.
Cardiovascular Centre, Aalst, Belgium.
Michalis I
MI
Hamilos
Miodrag
M
Ostojic
Branko
B
Beleslin
Dragan
D
Sagic
Ljubco
L
Mangovski
Sinisa
S
Stojkovic
Milan
M
Nedeljkovic
Dejan
D
Orlic
Bratislav
B
Milosavljevic
Dragan
D
Topic
Nevena
N
Karanovic
William
W
Wijns
D017023:Coronary Angiography; D003331:Coronary Vessels / Q000187:drug effects / Q000503:physiopathology*; D054855:Drug-Eluting Stents; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use*; D014661:Vasoconstriction / Q000187:drug effects*; D014664:Vasodilation / Q000187:drug effects*
D007166:Immunosuppressive Agents; D017239:Paclitaxel; C518022:umirolimus; D020123:Sirolimus