Local vascular dysfunction after coronary paclitaxel-eluting stent implantation

Int J Cardiol. 2007 Aug 21;120(2):212-20. doi: 10.1016/j.ijcard.2006.09.021. Epub 2007 Jan 17.


Background: Paclitaxel-eluting stents (PES) have been shown to reduce the rate of restenosis and the need for repeated revascularization procedures compared with bare metal stents. However, long-term effects of paclitaxel on vascular function are unknown. The purpose of the present study was to assess coronary vasomotor response to exercise after paclitaxel-eluting stent implantation.

Methods: Coronary vasomotion was evaluated by biplane quantitative coronary angiography at rest and during supine bicycle exercise in 27 patients with coronary artery disease. Twelve patients were treated with a bare metal stent (controls), and fifteen patients with a paclitaxel-eluting stent. All patients were restudied 6+/-2 (range 2-12) months after stent implantation. Minimal luminal diameter, stent diameter, proximal, distal and a reference vessel diameter were determined.

Results: Reference vessels showed exercise-induced vasodilation in both groups (+20+/-5% controls; +26+/-3% PES group). Vasomotion within the stented vessel segments was abolished. In the controls, the adjacent segments proximal and distal to the stent showed exercise-induced vasodilation (+17+/-3% and +24+/-4%). In contrast, there was exercise-induced vasoconstriction of the proximal and distal vessel segments adjacent to the paclitaxel-eluting stent (-13+/-6% and -18+/-4%; p<0.005). After sublingual nitroglycerin, the proximal and distal vessel segments dilated in both groups. Exercise-induced vasoconstriction adjacent to paclitaxel-eluting stent correlated inversely with the time interval after stent implantation.

Conclusions: Paclitaxel-eluting stent implantation is associated with exercise-induced vasoconstriction in the persistent region suggesting endothelial dysfunction as the underlying mechanism. Improvement of vascular function occurs over time, indicating delayed vascular healing.

MeSH terms

  • Administration, Sublingual
  • Antineoplastic Agents, Phytogenic / pharmacology
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / instrumentation*
  • Coated Materials, Biocompatible / adverse effects*
  • Coronary Angiography
  • Coronary Restenosis / prevention & control
  • Coronary Stenosis / surgery*
  • Coronary Vasospasm / diagnostic imaging
  • Coronary Vasospasm / etiology*
  • Coronary Vasospasm / physiopathology
  • Diagnosis, Differential
  • Electrocardiography
  • Exercise Test
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Nitroglycerin / administration & dosage
  • Paclitaxel / pharmacology*
  • Postoperative Complications
  • Stents / adverse effects*
  • Time Factors
  • Treatment Outcome
  • Vasoconstriction / physiology*
  • Vasodilator Agents / administration & dosage


  • Antineoplastic Agents, Phytogenic
  • Coated Materials, Biocompatible
  • Vasodilator Agents
  • Nitroglycerin
  • Paclitaxel