Abstract
The use of drug-eluting stent (DES) has been associated with incomplete endothelialization and coronary endothelial dysfunction. However, the relationship between endothelial vasomotor function and strut coverage evaluated by optical coherence tomography (OCT) has not been sufficiently assessed. Therefore, we evaluated the relationship between endothelial vasomotor function and the degree of stent strut coverage after DES implantation. Coronary angiography and OCT were performed in 112 patients at the 6-month follow-up after DES implantation. The patients were divided into tertiles according to the degree of strut coverage as was assessed by OCT. Endothelial vasomotor function was evaluated with intracoronary infusion of incremental doses of acetylcholine (Ach; 10−8–10−6 mol/L). Vascular responses at the proximal and distal segments to the stent margin were evaluated by quantitative coronary angiography analysis before and after Ach infusion. The percentage of uncovered struts in tertiles 1–3 was 4.2 ± 3.3, 17.3 ± 4.2 and 44.5 ± 14.4 %, respectively, (p < 0.001). The percentage of maximal vasoconstriction in tertiles 1–3 was 8.3, 9.1 and 8.1 % at proximal segment to the stent margin (p = 0.95), respectively, and 13.9, 11.1 and 14.2 % at distal segment to the stent margin (p = 0.74), respectively. The percentage of uncovered struts was not correlated with the degree of vasomotor function (r = −0.01, p = 0.92 at the proximal segment; r = −0.07, p = 0.47 at the distal segment). The percentage of strut coverage was not associated with the degree of abnormal vasoconstriction in response to intracoronary infusion of Ach 6 months after DES implantation.
Similar content being viewed by others
References
Muhlestein JB (2008) Endothelial dysfunction associated with drug-eluting stents what, where, when, and how? J Am Coll Cardiol 51:2139–2140
Hamilos MI, Ostojic M, Beleslin B, Sagic D, Mangovski L, Stojkovic S, Nedeljkovic M, Orlic D, Milosavljevic B, Topic D, Karanovic N, Wijns W, Nobori Core investigators (2008) Differential effects of drug-eluting stents on local endothelium-dependent coronary vasomotion. J Am Coll Cardiol 51:2123–2129
Joner M, Finn AV, Farb A, Mont KE, Kolodgie FD, Ladich E, Kutys R, Skorija K, Gold HK, Virmani R (2006) Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol 48:193–202
Jeremias A, Sylvia B, Bridges J, Kirtane AJ, Bigelow B, Pinto DS, Ho KK, Cohen DJ, Garcia LA, Cutlip DE, Carrozza JP Jr (2004) Stent thrombosis after successful sirolimus-eluting stent implantation. Circulation 109:1930–1932
Lerman A, Eeckhout E (2006) Coronary endothelial dysfunction following sirolimus-eluting stent placement: should we worry about it? Eur Heart J 27:125–126
Kim JW, Suh SY, Choi CU, Na JO, Kim EJ, Rha SW, Park CG, Seo HS, Oh DJ (2008) Six-month comparison of coronary endothelial dysfunction associated with sirolimus-eluting stent versus paclitaxel-eluting stent. J Am Coll Cardiol Interv 1:65–71
Hofma SH, van der Giessen WJ, van Dalen BM, Lemos PA, McFadden EP, Sianos G, Ligthart JM, van Essen D, de Feyter PJ, Serruys PW (2006) Indication of long-term endothelial dysfunction after sirolimus-eluting stent implantation. Eur Heart J 27:166–170
Togni M, Raber L, Cocchia R, Wenaweser P, Cook S, Windecker S, Meier B, Hess OM (2007) Local vascular dysfunction after coronary paclitaxel-eluting stent implantation. Int J Cardiol 120:212–220
Togni M, Windecker S, Cocchia R, Wenaweser P, Cook S, Billinger M, Meier B, Hess OM (2005) Sirolimus-eluting stents associated with paradoxic coronary vasoconstriction. J Am Coll Cardiol 46:231–236
Fujii K, Kawasaki D, Oka K, Akahori H, Fukunaga M, Sawada H, Masutani M, Lee-Kawabata M, Tsujino T, Ohyanagi M, Masuyama T (2011) Endothelium-dependent coronary vasomotor response and neointimal coverage of zotarolimus-eluting stents 3 months after implantation. Heart 97:977–982
Obata JE, Kitta Y, Takano H, Kodama Y, Nakamura T, Mende A, Kawabata K, Saitoh Y, Fujioka D, Kobayashi T, Yano T, Kugiyama K (2007) Sirolimus-eluting stent implantation aggravates endothelial vasomotor dysfunction in the infarct-related coronary artery in patients with acute myocardial infarction. J Am Coll Cardiol 50:1305–1309
Kim BK, Kim JS, Park JB, Ko YG, Choi D, Jang Y, Hong MK (2012) Comparison of optical coherence tomographic assessment between first- versus second-generation drug-eluting stents. Yonsei Med J 53:524–529
Takano M, Inami S, Jang IK, Yamamoto M, Murakami D, Seimiya K, Ohba T, Mizuno K (2007) Evaluation by optical coherence tomography of neointimal coverage of sirolimus-eluting stent three months after implantation. Am J Cardiol 99:1033–1038
Davlouros PA, Mavronasiou E, Xanthopoulou I, Karantalis V, Tsigkas G, Hahalis G, Alexopoulos D (2012) An optical coherence tomography study of two new generation stents with biodegradable polymer carrier, eluting paclitaxel vs. biolimus-A9. Int J Cardiol 157:341–346
Kim BK, Kim JS, Oh C, Ko YG, Choi D, Jang Y, Hong MK (2012) Major determinants for the uncovered stent struts on optical coherence tomography after drug-eluting stent implantation. Int J Cardiovasc Imaging 28:705–714
Mitsutake Y, Ueno T, Yokoyama S, Sasaki K, Sugi Y, Toyama Y, Koiwaya H, Ohtsuka M, Nakayoshi T, Itaya N, Chibana H, Kakuma T, Imaizumi T (2012) Coronary endothelial dysfunction distal to stent of first-generation drug-eluting stents. J Am Coll Cardiol Interv 5:966–973
Schachinger V, Britten MB, Zeiher AM (2000) Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation 101:1899–1906
Thanyasiri P, Kathir K, Celermajer DS, Adams MR (2007) Endothelial dysfunction and restenosis following percutaneous coronary intervention. Int J Cardiol 119:362–367
Sabate M, Kay IP, van Der Giessen WJ, Cequier A, Ligthart JM, Gomez-Hospital JA, Carlier SG, Coen VL, Marijnissen JP, Wardeh AJ, Levendag PC, Serruys PW (1999) Preserved endothelium-dependent vasodilation in coronary segments previously treated with balloon angioplasty and intracoronary irradiation. Circulation 100:1623–1629
Togni M, Windecker S, Wenaweser P, Tueller D, Kaisaier A, Maier W, Meier B, Hess OM (2004) Deleterious effect of coronary brachytherapy on vasomotor response to exercise. Circulation 110:135–140
Kwon SW, Kim BK, Kim TH, Kim JS, Ko YG, Choi D, Jang Y, Hong MK (2011) Qualitative assessment of neointimal tissue after drug-eluting stent implantation: comparison between follow-up optical coherence tomography and intravascular ultrasound. Am Heart J 161:367–372
Hamilos M, Sarma J, Ostojic M, Cuisset T, Sarno G, Melikian N, Ntalianis A, Muller O, Barbato E, Beleslin B, Sagic D, De Bruyne B, Bartunek J, Wijns W (2008) Interference of drug-eluting stents with endothelium-dependent coronary vasomotion: evidence for device-specific responses. Circ Cardiovasc Interv 1:193–200
Barlis P, Regar E, Serruys PW, Dimopoulos K, van der Giessen WJ, van Geuns RJ, Ferrante G, Wandel S, Windecker S, van Es GA, Eerdmans P, Juni P, di Mario C (2010) An optical coherence tomography study of a biodegradable vs. durable polymer-coated limus-eluting stent: a LEADERS trial sub-study. Eur Heart J 31:165–176
Katoh H, Shite J, Shinke T, Matsumoto D, Tanino Y, Ogasawara D, Sawada T, Miyoshi N, Kawamori H, Yoshino N, Hirata K (2009) Delayed neointimalization on sirolimus-eluting stents: 6-month and 12-month follow up by optical coherence tomography. Circ J 73:1033–1037
Shimokawa H (2002) Rho-kinase as a novel therapeutic target in treatment of cardiovascular diseases. J Cardiovasc Pharmacol 39:319–327
Nakayama M, Yoshimura M, Sakamoto T, Abe K, Yamamuro M, Shono M, Suzuki S, Nishijima T, Miyamoto Y, Saito Y, Nakao K, Yasue H, Ogawa H (2006) A-786T>C polymorphism in the endothelial nitric oxide synthase gene reduces serum nitrite/nitrate levels from the heart due to an intracoronary injection of acetylcholine. Pharmacogenet Genomics 16:339–345
Tanaka A, Shimada K, Tearney GJ, Kitabata H, Taguchi H, Fukuda S, Kashiwagi M, Kubo T, Takarada S, Hirata K, Mizukoshi M, Yoshikawa J, Bouma BE, Akasaka T (2011) Conformational change in coronary artery structure assessed by optical coherence tomography in patients with vasospastic angina. J Am Coll Cardiol 58:1608–1613
Acknowledgments
This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (No. A085012 and A102064), a grant from the Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea (No. A085136), and the Cardiovascular Research Center, Seoul, Korea.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Additional information
Hoyoun Won and Jung-Sun Kim have contributed equally to this paper.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Won, H., Kim, JS., Shin, DH. et al. Relationship between endothelial vasomotor function and strut coverage after implantation of drug-eluting stent assessed by optical coherence tomography. Int J Cardiovasc Imaging 30, 263–270 (2014). https://doi.org/10.1007/s10554-013-0325-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-013-0325-4