title: Coronary endothelial dysfunction distal to stent of first-generation drug-eluting stents.
abstract: OBJECTIVE
  This study sought to evaluate the relationship between coronary endothelial function and neointimal coverage after drug-eluting stent (DES) implantation.
  
  
  BACKGROUND
  The mechanisms of endothelial dysfunction after DES implantation remain to be fully elucidated. We hypothesized that poor neointimal coverage after DES implantation may be associated with endothelial dysfunction distal to the stent site.
  
  
  METHODS
  Sixty-six stable angina patients treated with a first-generation DES were enrolled. At 9-month follow-up, coronary endothelial function was evaluated with intracoronary infusion of incremental doses of acetylcholine (10(-8), 10(-7), and 10(-6) mol/l) and nitroglycerin (200 μg). Vascular responses at the segments proximal and distal to the stent site were angiographically and quantitatively measured. At the same time, the degree of neointimal coverage was evaluated using coronary angioscopy and classified into 4 grades: 0 (no coverage) to 3 (full coverage).
  
  
  RESULTS
  We divided the subjects into poor-coverage (grades 0 to 1, n = 33) and good-coverage (grades 2 to 3, n = 33) groups. Acetylcholine induced dose-dependent coronary vasoconstrictions in both groups. At the segment distal to the stent, the magnitude of vasoconstriction to acetylcholine in the poor-coverage group was significantly greater than in the good-coverage group (p < 0.001), whereas vasomotor responses proximal to the stent and vasodilation by nitroglycerine were similar between the 2 groups.
  
  
  CONCLUSIONS
  Coronary endothelial dysfunction distal to the stent was associated with poor neointimal coverage after DES implantation.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Mitsutake
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ueno
authors.forename: Shinji
authors.initials: S
authors.lastname: Yokoyama
authors.forename: Ken-ichiro
authors.initials: K
authors.lastname: Sasaki
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Sugi
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Toyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Koiwaya
authors.forename: Masanori
authors.initials: M
authors.lastname: Ohtsuka
authors.forename: Takaharu
authors.initials: T
authors.lastname: Nakayoshi
authors.forename: Naoki
authors.initials: N
authors.lastname: Itaya
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Chibana
authors.forename: Tatsuyuki
authors.initials: T
authors.lastname: Kakuma
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Imaizumi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D060050:Angina, Stable / Q000628:therapy*; D017546:Angioscopy; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology*; D004305:Dose-Response Relationship, Drug; D054855:Drug-Eluting Stents; D004730:Endothelium, Vascular / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D058426:Neointima; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011474:Prosthesis Design; D013997:Time Factors; D016896:Treatment Outcome; D014661:Vasoconstriction / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D014664:Vasodilation / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents