Local vascular dysfunction after coronary paclitaxel-eluting stent implantation

Togni, Mario; Räber, Lorenz; Cocchia, Rosangela; Wenaweser, Peter; Cook, Stephane; Windecker, Stephan; Meier, Bernhard; Hess, Otto M (2007). Local vascular dysfunction after coronary paclitaxel-eluting stent implantation. International journal of cardiology, 120(2), pp. 212-20. Amsterdam: Elsevier 10.1016/j.ijcard.2006.09.021

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BACKGROUND: Paclitaxel-eluting stents (PES) have been shown to reduce the rate of restenosis and the need for repeated revascularization procedures compared with bare metal stents. However, long-term effects of paclitaxel on vascular function are unknown. The purpose of the present study was to assess coronary vasomotor response to exercise after paclitaxel-eluting stent implantation. METHODS: Coronary vasomotion was evaluated by biplane quantitative coronary angiography at rest and during supine bicycle exercise in 27 patients with coronary artery disease. Twelve patients were treated with a bare metal stent (controls), and fifteen patients with a paclitaxel-eluting stent. All patients were restudied 6+/-2 (range 2-12) months after stent implantation. Minimal luminal diameter, stent diameter, proximal, distal and a reference vessel diameter were determined. RESULTS: Reference vessels showed exercise-induced vasodilation in both groups (+20+/-5% controls; +26+/-3% PES group). Vasomotion within the stented vessel segments was abolished. In the controls, the adjacent segments proximal and distal to the stent showed exercise-induced vasodilation (+17+/-3% and +24+/-4%). In contrast, there was exercise-induced vasoconstriction of the proximal and distal vessel segments adjacent to the paclitaxel-eluting stent (-13+/-6% and -18+/-4%; p<0.005). After sublingual nitroglycerin, the proximal and distal vessel segments dilated in both groups. Exercise-induced vasoconstriction adjacent to paclitaxel-eluting stent correlated inversely with the time interval after stent implantation. CONCLUSIONS: Paclitaxel-eluting stent implantation is associated with exercise-induced vasoconstriction in the persistent region suggesting endothelial dysfunction as the underlying mechanism. Improvement of vascular function occurs over time, indicating delayed vascular healing.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Räber, Lorenz; Wenaweser, Peter Martin; Cook, Stéphane; Windecker, Stephan; Meier, Bernhard and Hess, Otto

ISSN:

0167-5273

ISBN:

17234280

Publisher:

Elsevier

Language:

English

Submitter:

Lorenz Räber

Date Deposited:

04 Oct 2013 14:54

Last Modified:

04 May 2014 23:16

Publisher DOI:

10.1016/j.ijcard.2006.09.021

PubMed ID:

17234280

Web of Science ID:

000248799300012

URI:

https://boris.unibe.ch/id/eprint/23225 (FactScience: 40643)

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