Interference of drug-eluting stents with endothelium-dependent coronary vasomotion: evidence for device-specific responses.
BACKGROUND
There is evidence that endothelial coverage of drug-eluting stents might be delayed or absent, a risk factor for late thrombotic events. We studied the effects of different drug-polymer-device iterations on endothelium-dependent coronary vasomotion. Systemic markers of endothelial inflammation were correlated with coronary vasomotor changes.


RESULTS
Patients with paclitaxel-eluting stents (n=11), sirolimus-eluting stents (n=21), biolimus A9-eluting stents (n=28), zotarolimus-eluting stents (n=10), and bare-metal stents (n=13) were studied 10, 9, 9, 9, and 12 months after implantation, respectively. Endothelium-dependent coronary vasomotion was tested proximally and distally to the stent and at a reference vessel segment during atrial pacing at increasing heart rates by quantitative coronary angiography. Indexes of platelet-monocyte binding and other biomarkers were studied in a subgroup of 19 patients. The baseline characteristics and hemodynamics of the patients in the different stent groups were comparable. Significant differences were observed across the 5 stent groups, concerning the vasomotion of segments proximal (P=0.006) and distal (P=0.003) to the stent. Normal vasomotion (vasodilatation) was maintained in the biolimus A9-eluting stent, zotarolimus-eluting stent, and bare-metal stent groups, whereas vasoconstriction was observed in the sirolimus-eluting stent and paclitaxel-eluting stent groups. Platelet-monocyte binding in whole blood showed a significant inverse correlation with vasomotion in reference but not in segments adjacent to the stent (r=-0.57; P=0.01).


CONCLUSIONS
Paclitaxel-eluting stents and sirolimus-eluting stents seem to cause endothelial dysfunction of the implanted vessel, whereas biolimus A9-eluting stents and zotarolimus-eluting stents behave more closely to bare-metal stents, with preserved endothelial vasomotor response. Coronary vasoconstriction was not associated with detectable systemic endothelial activation.
Hamilos
Michalis
M
Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst, Belgium
Sarma
Jaydeep
J
Ostojic
Miodrag
M
Cuisset
Thomas
T
Sarno
Giovanna
G
Melikian
Narbeh
N
Ntalianis
Argyrios
A
Muller
Olivier
O
Barbato
Emanuele
E
Beleslin
Branco
B
Sagic
Dragan
D
De Bruyne
Bernard
B
Bartunek
Jozef
J
Wijns
William
W
D001792:Blood Platelets / Q000502:physiology; D002317:Cardiovascular Agents / Q000494:pharmacology; D002449:Cell Aggregation / Q000502:physiology; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000187:drug effects* / Q000502:physiology; D054855:Drug-Eluting Stents; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000502:physiology; D019007:P-Selectin / Q000378:metabolism; D017239:Paclitaxel / Q000494:pharmacology; D020123:Sirolimus / Q000031:analogs & derivatives / Q000494:pharmacology; D014661:Vasoconstriction / Q000187:drug effects* / Q000502:physiology; D014664:Vasodilation / Q000187:drug effects* / Q000502:physiology
D002317:Cardiovascular Agents; D019007:P-Selectin; C489443:zotarolimus; D017239:Paclitaxel; C518022:umirolimus; D020123:Sirolimus