Shin Dong Il, Kim Pum Joon, Seung Ki-Bae, Kim Dong Bin, Kim Mi-Jeong, Chang Kiyuk, Lim Sung Min, Jeon Doo Soo, Chung Wook Sung, Baek Sang Hong, Lee Man Young
Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea.
Int Heart J. 2007 Sep;48(5):553-67. doi: 10.1536/ihj.48.553.
Drug-eluting stent (DES) implantation may be associated with endothelial dysfunction. However, changes in long-term endothelial function based on the type of DES remain largely unknown. We assessed coronary endothelial function after DES implantation compared to bare-metal stents (BMS) and determined the differences according to DES type. Patients who had single BMS or DES implantation in the left anterior descending artery and showed no restenosis in follow-up angiography at 6 to 9 months were assigned to the BMS group (5 patients) or DES group (9 sirolimus-eluting stents, SES, and 8 paclitaxel-eluting stents, PES). Endothelium-dependent vasomotion, after intracoronary infusion of acetylcholine, was determined by quantitative coronary angiography. Also, endothelium-independent vasomotion was assessed after nitrate infusion. In the distal and far distal segments, the SES (SES versus BMS, distal: -27.6 +/- 16.3% versus -0.6 +/- 1.6%; P = 0.01, far distal: -24.8 +/- 13.2% versus -0.9 +/- 1.3%; P = 0.02) and PES groups (PES versus BMS, distal: -25.4 +/- 17.1% versus -0.6 +/- 1.6%; P = 0.01, far distal: -26.6 +/- 15.9% versus -0.9 +/- 1.3%; P = 0.01) had similar patterns showing significant vasoconstriction compared with the BMS group. In addition, the DES group showed a significant reduction of diameter in distal (SES: P = 0.001, PES: P = 0.04) and far distal segments (SES: P = 0.002, PES: P = 0.001) compared with proximal and near proximal segments. However, the BMS group did not demonstrate significantly different vasomotion between proximal and distal segments. Vasodilatation by nitrate infusion was preserved in all subjects. SES or PES implantation could be associated with the similar pattern of endothelial dysfunction identified predominantly in the long distal portion of the treated vessel.
药物洗脱支架（DES）植入可能与内皮功能障碍有关。然而，基于DES类型的长期内皮功能变化在很大程度上仍不清楚。我们评估了DES植入后与裸金属支架（BMS）相比的冠状动脉内皮功能，并根据DES类型确定了差异。在左前降支植入单个BMS或DES且在6至9个月的随访血管造影中未显示再狭窄的患者被分配到BMS组（5例患者）或DES组（9个西罗莫司洗脱支架，SES，和8个紫杉醇洗脱支架，PES）。冠状动脉内注入乙酰胆碱后，通过定量冠状动脉造影确定内皮依赖性血管运动。此外，在注入硝酸盐后评估非内皮依赖性血管运动。在远端和远远端节段，SES组（SES与BMS相比，远端：-27.6±16.3%对-0.6±1.6%；P = 0.01，远远端：-24.8±13.2%对-0.9±1.3%；P = 0.02）和PES组（PES与BMS相比，远端：-25.4±17.1%对-0.6±1.6%；P = 0.01，远远端：-26.6±15.9%对-0.9±1.3%；P = 0.01）与BMS组相比有相似的模式，显示出明显的血管收缩。此外，与近端和近端附近节段相比，DES组在远端（SES：P = 0.001，PES：P = 0.04）和远远端节段（SES：P = 0.002，PES：P = 0.001）的直径有显著减小。然而，BMS组在近端和远端节段之间未显示出显著不同的血管运动。所有受试者通过注入硝酸盐后的血管舒张功能均得以保留。SES或PES植入可能与主要在治疗血管的长远端部分发现的相似内皮功能障碍模式有关。
