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(Circulation. 2006;113:e850-e851.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Severe Endothelial Dysfunction After Sirolimus-Eluting Stent Implantation

Kiyoaki Maekawa, MD; Kenji Kawamoto, MD; Soichiro Fuke, MD; Ryo Yoshioka, MD; Hironori Saito, MD; Tetsuya Sato, MD; Toru Hioka, MD

From Cardiovascular Medicine, Okayama Red Cross General Hospital, Okayama, Japan.

Correspondence to Kiyoaki Maekawa, MD, 2-1-1, Aoe, Okayama-City, Okayama 700-8607, Japan. E-mail maekawa@okayama-med.jrc.or.jp

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 40-year-old man with a recent anterior myocardial infarction but with no history of coronary spasm and no risk factors for endothelial dysfunction such as diabetes mellitus, hypertension, smoking, or hypercholesterolemia was admitted to our hospital. Coronary angiography showed diffuse 90% proximal left anterior descending artery stenosis (Figure 1A). He received a sirolimus-eluting stent (Cypher, Cordis Corporation, Miami Lakes, Fla) to treat diffuse long left anterior descending stenosis on January 20, 2005 (Figure 1B). After predilation, 3 Cypher stents (2.5x28 mm, 2.5x28 mm, and 3.0x23 mm) were deployed, overlapping 3 mm at nominal pressure. Overlapped segments were postdilated at 18 atm. Finally, complete expansion was obtained, and the lesion was fully covered. The patient remained asymptomatic after stenting. Follow-up angiography at 6 months on June 9, 2005, showed 0% stenosis (Figure 2A). To evaluate endothelium-dependent vasomotor response, we performed intracoronary infusion of acetylcholine at 0.14 µg/min over a period of 2 minutes, yielding estimated intracoronary concentrations of 10^–8 mol/L. Angiography repeated immediately after acetylcholine infusion showed total occlusion at the middle portion of the stents (Figure 2B) associated with chest pain and ST elevation. No vasoconstrictive response was observed in any other coronary artery. Intracoronary nitroglycerin (250 µg, bolus) quickly and completely resolved this angiographic obstruction (Figure 2C). In this case, severe vasoconstrictive response was produced by small-dose intracoronary acetylcholine infusion. This phenomenon indicated severe endothelial dysfunction in the sirolimus-eluting stent at 6 months . . . [Full Text of this Article]

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