Key result
First-generation DES are linked to coronary endothelial dysfunction and paradoxical vasoconstriction contributing to late thrombosis.
This review highlights coronary endothelial dysfunction and spasm as potential complications after DES implantation, though direct links to late stent thrombosis remain unproven.
May warrant vigilance for endothelial dysfunction after first-generation DES; leaves open its causal role in late stent thrombosis.
Problem statement: Stent thrombosis, which may occur even one year after stent implantation, is a drawback of Drug-Eluting Stents (DES). Among the variety of causes of stent thrombosis after DES implantation, coronary endothelial dysfunction manifested or exaggerated by DES implantation should not be overlooked. This review article summarizes previous reports on coronary endothelial dysfunction after DES implantation and/or coronary spasm and discusses the mechanism, clinical implications and prognosis. Although novel stents that do not impair endothelial function will most likely be developed in the near future, millions of patients have already undergone implantation of a first or second generation DES. Conclusion/Recommendations: Some studies have reported that a drug improves the impairment of endothelial function. On the other hand, no direct relationships between spasm and stent thrombosis after DES implantation have been reported. A larger study is warranted to clarify the clinical significance of this important clinical issue.
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Sheroz (2012) conducted a review in Coronary Endothelial Dysfunction. Drug-Eluting Stents (DES) vs. Bare-Metal Stents (BMS) was evaluated. Drug-eluting stents, particularly first-generation types, are associated with coronary endothelial dysfunction and paradoxical vasoconstriction, which may contribute to late stent thrombosis.
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