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Original Articles

Interference of Drug-Eluting Stents With Endothelium-Dependent Coronary Vasomotion

Evidence for Device-Specific Responses

Michalis Hamilos, MD, PhD; Jaydeep Sarma, MD, PhD; Miodrag Ostojic, MD, PhD; Thomas Cuisset, MD; Giovanna Sarno, MD; Narbeh Melikian, BSc, MBBS, MRCP; Argyrios Ntalianis, MD, PhD; Olivier Muller, MD, PhD; Emanuele Barbato, MD, PhD; Branco Beleslin, MD, PhD; Dragan Sagic, MD, PhD; Bernard De Bruyne, MD, PhD; Jozef Bartunek, MD, PhD and William Wijns, MD, PhD

From the Cardiovascular Centre Aalst (M.H., J.S., T.C., G.S., N.M., A.N., O.M., E.B., B.D.E., J.B., W.W.), Belgium; the Department of Cardiology (M.O., B.B.), University Institute for Cardiovascular Diseases, Clinical Center of Serbia, Serbia; and Institute for Cardiovascular Disease (D.S.), Dedinje, Serbia.

Correspondence to William Wijns, MD, PhD, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan, 164, B-9300 Aalst, Belgium. E-mail william.wijns{at}belgacom.net

Received June 13, 2008; accepted October 27, 2008.

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.

Methods and 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.

Key Words: endothelium • stents • coronary vasomotion • platelet-monocyte binding

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CLINICAL PERSPECTIVE

Related Article

Interference of Drug-Eluting Stents With Endothelium-Dependent Coronary Vasomotion: Evidence for Device-Specific Responses

Michalis Hamilos, Jaydeep Sarma, Miodrag Ostojic, Thomas Cuisset, Giovanna Sarno, Narbeh Melikian, Argyrios Ntalianis, Olivier Muller, Emanuele Barbato, Branco Beleslin, Dragan Sagic, Bernard De Bruyne, Jozef Bartunek, and William Wijns
Circ Cardiovasc Interv 2008 1: 193-200. [Abstract] [Full Text] [PDF]

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