Hofma Sjoerd H, van der Giessen Wim J, van Dalen Bas M, Lemos Pedro A, McFadden Eugene P, Sianos Georgios, Ligthart Jurgen M R, van Essen Dirk, de Feyter Pim J, Serruys Patrick W
Department of Cardiology, Thoraxcenter, Erasmus MC, Bd 412, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Eur Heart J. 2006 Jan;27(2):166-70. doi: 10.1093/eurheartj/ehi571. Epub 2005 Oct 25.
Endothelial dysfunction has been related both to progression of atherosclerotic disease and to future cardiovascular events. We assessed local epicardial endothelial function 6 months after sirolimus-eluting stent (SES) or bare metal stent (BS) implantation.
In 12 patients (seven SES, five BS), endothelium-dependent vasomotion of a coronary segment 15 mm in length, starting 2 mm distal to the stent, was assessed with quantitative coronary angiography immediately after the procedure and at 6 months follow-up, after intracoronary infusion of acetylcholine. Intravascular ultrasound (IVUS) was performed and coronary flow reserve (CFR) assessed in all patients. At follow-up significant vasoconstriction was seen in SES (median 32% diameter reduction from baseline) but not in BS (median 2% reduction) patients after acetylcholine infusion (P=0.03 for SES vs. BS); endothelium-independent vasodilatation to nitrates did not differ significantly between groups (20% SES, 5% BS, P=0.14). IVUS revealed no late unhealed dissections and CFR was comparable between groups (SES 3.1 vs. BS 3.2, n.s.).
SES implantation may have an adverse effect on local endothelium-dependent vasomotor responses compared with BS implantation at 6 months. Long-term clinical consequences of this observation are still unknown.
内皮功能障碍与动脉粥样硬化疾病的进展以及未来心血管事件均有关联。我们评估了西罗莫司洗脱支架（SES）或裸金属支架（BS）植入6个月后局部心外膜内皮功能。
12例患者（7例植入SES，5例植入BS），在术后即刻以及冠状动脉内注射乙酰胆碱后6个月随访时，通过定量冠状动脉造影评估距支架远端2mm起长度为15mm的冠状动脉节段的内皮依赖性血管运动。对所有患者进行血管内超声（IVUS）检查并评估冠状动脉血流储备（CFR）。随访时，注射乙酰胆碱后，SES组出现显著血管收缩（直径较基线中位数降低32%），而BS组未出现（中位数降低2%）（SES组与BS组比较，P = 0.03）；两组对硝酸盐的非内皮依赖性血管舒张无显著差异（SES组为20%，BS组为5%，P = 0.14）。IVUS显示无晚期未愈合夹层，两组CFR相当（SES组为3.1，BS组为3.2，无显著性差异）。
与植入BS相比，植入SES在6个月时可能对局部内皮依赖性血管运动反应产生不利影响。这一观察结果的长期临床后果仍不明确。
