Sirolimus-eluting stents may cause endothelial dysfunction leading to late recurrent vasospasm and myocardial infarction, which may be managed with a different drug-eluting stent platform.
May signal late endothelial dysfunction after sirolimus-eluting stents; leaves open whether alternative platforms prevent recurrent events.
A 67-year-old male with stable angina was admitted to our cardiovascular center. He had neither any history of smoking, diabetes mellitus, hypertension, cerebrovascular accident nor family history of coronary artery disease. Coronary angiography showed a 90% tubular eccentric luminal narrowing at the mid left anterior descending artery (m-LAD). A sirolimus-eluting stent (SES) was implanted in the m-LAD. Coronary angiography performed after 9 months did not reveal restenosis or recurrent coronary artery disease. However, the patient returned to the emergency room with severe chest pain after 17 months. Coronary angiography showed severe diffuse vasospasm distal to the m-LAD stent site. After 20 days, vasospastic myocardial infarction developed. A zotarolimuseluting stent with a phosphorylcholine polymer was implanted distal to the m-LAD stent. The zotarolimus-eluting stent was used because the polymer in the SES or sirolimus was considered a possible cause for the recurrent vasospasm. The patient had no further chest pain during the 9 months after zotarolimus-eluting stent implantation. We suspect that the polymer in the SES or sirolimus might have caused endothelial dysfunction and provoked the late vasospasm. Here, we describe this case of late recurrent vasospasm after SES implantation. (Korean Circ J 2008;38:174-178)
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Lee et al. (2008) studied this question.
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