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Serial changes of coronary endothelial function and arterial healing after paclitaxel-eluting stent implantation

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Abstract

Several studies have shown coronary endothelial dysfunction and delayed arterial healing associated with first-generation drug-eluting stents. However, it remains unclear whether those issues persist for a longer term. We thus evaluated serial changes in endothelial function and intra-stent condition after paclitaxel-eluting stents (PES) implantation. Eight patients with stable effort angina were assessed at 9 and over 24 months (1st and 2nd follow-up) after PES implantation. Endothelial function was evaluated with intracoronary infusion of acetylcholine (Ach). Vascular responses were quantitatively measured. Intra-stent condition was evaluated using angioscopy. We assessed (1) the degree of neointimal coverage over the stent (grade 0: no coverage to grade 3: full coverage); (2) presence of yellow intima inside the stent, and (3) existence of in-stent thrombus. Vasomotions proximal to the stent at 2nd follow-up significantly improved compared with 1st follow-up (p = 0.04), whereas vascular responses at the distal segment did not differ between 1st and 2nd follow-up (p = 0.19). From the angioscopic study, the average of coverage grading was comparable between the 2 points (0.9 ± 0.8 vs. 1.3 ± 1.0, p = 0.20). In addition, the incidence of yellow intima and in-stent thrombus did not differ between 1st and 2nd follow-up (yellow intima; 50 vs. 37.5 %, p = 1.0, thrombus; 75 vs. 50 %, p = 0.61). Endothelial dysfunction and delayed healing with PES could attenuate gradually, but these issues may persist over 24 months in some patients.

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Abbreviations

Ach:

Acetylcholine

DES:

Drug-eluting stents

NTG:

Nitroglycerine

PCI:

Percutaneous coronary intervention

PES:

Paclitaxel-eluting stents

QCA:

Quantitative coronary angiography

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Acknowledgments

We thank Ms. Ogura (Kurume University) for the technical assistance. The authors also thank Heidi N. Bonneau, RN, MS, CCA for her review of the manuscript. No financial support for this study was provided and the authors report no conflicts of interest.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan

    Yoshiaki Mitsutake, Takafumi Ueno, Shinji Yokoyama, Ken-ichiro Sasaki, Takaharu Nakayoshi, Naoki Itaya, Hidetoshi Chibana, Masahiro Sasaki & Yoshihiro Fukumoto

  2. Division of Cardiovascular Medicine, Stanford University, Stanford, USA

    Fumiaki Ikeno

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  1. Yoshiaki Mitsutake
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  2. Takafumi Ueno
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  3. Fumiaki Ikeno
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  4. Shinji Yokoyama
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  5. Ken-ichiro Sasaki
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  6. Takaharu Nakayoshi
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  7. Naoki Itaya
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  9. Masahiro Sasaki
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  10. Yoshihiro Fukumoto
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Correspondence to Yoshiaki Mitsutake.

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Mitsutake, Y., Ueno, T., Ikeno, F. et al. Serial changes of coronary endothelial function and arterial healing after paclitaxel-eluting stent implantation. Cardiovasc Interv and Ther 31, 21–28 (2016). https://doi.org/10.1007/s12928-015-0341-5

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  • DOI: https://doi.org/10.1007/s12928-015-0341-5

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