Long-term endothelial dysfunction after coronary artery stenting

Caramori, Paulo; Lima, Valter C.; Seidelin, Peter H.; Newton, Gary E.; Parker, John D.; Adelman, Allan G.

doi:10.1016/s0735-1097(99)00411-8

Cited by 99 publications

(70 citation statements)

References 15 publications

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“…13,14 Caramori et al used acetylcholine to demonstrate long-term endothelial dysfunction after BMS implantation in human coronary arteries, 14 whereas in our study, there was not a significant vasoconstrictive response at the peri-stent area with BMS. The different vasoconstrictive responses between these 2 studies may be, in part, related to the acetylcholine concentration.…”

Section: Endothelial Function After Bms Implantationcontrasting

confidence: 68%

Impaired Endothelial Vasomotor Function After Sirolimus-Eluting Stent Implantation

Fuke

Maekawa

Kono

et al. 2007

Circ J

106

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he sirolimus-eluting stent (SES) is a stent coated with sirolimus, and is reported to prevent neo-intimal proliferation and injury-induced arterial intimal thickening. 1 It is widely used to treat coronary stenotic lesions because of the associated very low rates of in-stent restenosis and need for target lesion revascularization compared with conventional bare metal stents (BMS). [2][3][4] Sirolimus is a macrolide antifungal agent with antiproliferative and immunosuppressant properties. It inhibits vascular smooth muscle cell proliferation via cell cycle arrest in the late G1 phase. 5 It also inhibits endothelial cell proliferation and smooth muscle progenitor cell circulation. 6 Experimental studies using sirolimus 7,8 have reported a decrease in endothelial function in vitro, but the effects of SES on endothelial vasomotor function in humans is not well known. 9 The present study aimed to evaluate the influence of SES implantation on endothelial vasomotor function 6 months following stent implantation, using a pharmacological acetylcholine test. To clarify whether endothelial dysfunction was already present before SES implantation, we examined vasomotor tone of the coronary segment before stenting in a subgroup study, and compared endothelium-dependent vasomotor function before and 6 months after SES implantation. Methods Study PopulationFrom August 2004 to June 2005, a total of 23 patients who had stable angina pectoris and underwent successful SES (Cypher, Cordis Corp, Miami Lakes, FL, USA) implantation were included in this study. The control group consisted of 12 patients who had significant coronary artery stenosis, and were successfully treated with BMS. Exclusion criteria were acute coronary syndrome, any coronary revascularization site, reperfused coronary arteries, stent restenosis, history of coronary spasm, symptomatic congestive heart failure, atrial fibrillation, severe valvular heart disease, previous coronary bypass graft surgery, and left main coronary artery or bifurcation lesions. Risk factors for endothelial dysfunction were assessed, and patients with insulin-dependent diabetes mellitus, hypertension (systolic blood pressure ≥140 mmHg), currently smoking, hypercholesterolemia (total cholesterol ≥240 mg/dl) were also excluded. Patients in a stable condition who returned for the 6-month angiographic follow-up formed the final study population. Study ProtocolAll participants gave written informed consent for coronary angiography and the endothelial function test. The Background Sirolimus inhibits endothelial cell proliferation in vitro, but although the sirolimus-eluting stent (SES) is widely used because of the very low rates of in-stent restenosis, the influence of SES on coronary endothelial vasomotor function in humans is not well known. Methods and ResultsThe present study included 21 patients treated with SES, and 12 patients treated with conventional bare metal stent (BMS). Endothelium-dependent vasomotor function was evaluated 6 months after stent implantation, using intracoronary ace...

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Section: Endothelial Function After Bms Implantationcontrasting

confidence: 68%

Impaired Endothelial Vasomotor Function After Sirolimus-Eluting Stent Implantation

Fuke

Maekawa

Kono

et al. 2007

Circ J

106

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“…Gage et al 21 and Gordon et al 25 have shown vasoconstriction of stenotic but vasodilation of normal coronary vessel segments in response to exercise. Recently, we reported that stent implantation does not impair exercise-induced coronary artery vasodilation proximal and distal to the stented vessel, 17 as it was reported by Caramori et al 26 Sabate et al 19 have reported preserved endothelium-dependent vasodilation 6 months after brachytherapy, assessed by the vasomotor response to acetylcholine infusion. The contrary findings may be related to (1) the different techniques for measuring coronary vasomotor response (ie, pharmacological assessment of endothelial function by acetylcholine infusion versus flow-mediated changes induced by bicycle exercise) and (2) the different radiation dose (our brachytherapy group received 20 Gy, the brachytherapy group studied by Sabate et al, 19 14 Gy).…”

Section: Limitationssupporting

confidence: 61%

Deleterious Effect of Coronary Brachytherapy on Vasomotor Response to Exercise

et al. 2004

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Background-Intracoronary radiotherapy (brachytherapy) has been proposed as treatment option for in-stent restenosis.Long-term results of brachytherapy with regard to vascular integrity and vasomotor responsiveness are unknown. The purpose of the present study was to determine the vasomotor response after brachytherapy and to assess its influence on vasomotion during exercise. Methods and Results-Biplane quantitative coronary angiography was performed at rest and during bicycle exercise in 27 patients with coronary artery disease. Fourteen patients underwent coronary stenting and were studied 10Ϯ3 months after intervention (control group). Thirteen patients were treated with brachytherapy (Guidant Galileo System) for in-stent restenosis with a mean dosis of 20 Gy at 1 mm into the vessel wall and were studied 9Ϯ1 months after radiation (brachytherapy group). Minimal luminal area, stent area, and proximal, distal, and a reference vessel area were determined. The reference vessel showed exercise-induced vasodilation (26Ϯ4%, PϽ0.001) in both groups. Vasomotion within the stented vessel segments was abolished. In control subjects, the proximal and distal segments showed exercise-induced vasodilation (17Ϯ2% and 22Ϯ7%, respectively; PϽ0.005). In contrast, there was exercise-induced vasoconstriction in the proximal and distal vessel segments of the brachytherapy group (Ϫ14Ϯ3% and Ϫ16Ϯ4%, respectively; PϽ0.01). Sublingual nitroglycerin was associated with maximal vasodilation of the proximal and distal vessel segments in both groups. Conclusions-Normal

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“…Enhanced endothelial dysfunction following BMS implantation has been reported (Caramori et al, 1999;Beusekom et al, 1998). The results are slightly different between reports.…”

Section: Stentmentioning

confidence: 72%

Coronary Endothelial Dysfunction after Drug-Eluting Stent Implantation

Ito¹

2012

American Medical Journal

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Problem statement: Stent thrombosis, which may occur even one year after stent implantation, is a drawback of Drug-Eluting Stents (DES). Among the variety of causes of stent thrombosis after DES implantation, coronary endothelial dysfunction manifested or exaggerated by DES implantation should not be overlooked. This review article summarizes previous reports on coronary endothelial dysfunction after DES implantation and/or coronary spasm and discusses the mechanism, clinical implications and prognosis. Although novel stents that do not impair endothelial function will most likely be developed in the near future, millions of patients have already undergone implantation of a first or second generation DES. Conclusion/Recommendations: Some studies have reported that a drug improves the impairment of endothelial function. On the other hand, no direct relationships between spasm and stent thrombosis after DES implantation have been reported. A larger study is warranted to clarify the clinical significance of this important clinical issue.

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Long-term endothelial dysfunction after coronary artery stenting

Abstract: More severe endothelial dysfunction was observed long term after stenting as compared to BA or DCA. These findings may have implications with respect to the progression of atherosclerosis in coronary arteries subjected to percutaneous interventions.

Cited by 99 publications

References 15 publications

Impaired Endothelial Vasomotor Function After Sirolimus-Eluting Stent Implantation

Impaired Endothelial Vasomotor Function After Sirolimus-Eluting Stent Implantation

Deleterious Effect of Coronary Brachytherapy on Vasomotor Response to Exercise

Coronary Endothelial Dysfunction after Drug-Eluting Stent Implantation

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