Coronary vasomotion dysfunction after everolimus-eluting stent implantation

Abstract

First generation drug-eluting stent can cause a paradoxical "in-segment" coronary vasoconstriction. This phenomenon was seen with sirolimus, paclitaxel, and, more recently, also with zotarolimus-eluting stent. For the first time, we describe a case of coronary-induced vasoconstriction by everolimus-eluting stents (EES).

Keywords: DES; coronary artery disease; coronary flow reserve; coronary spasm; everolimus-eluting stent.

Fig. 1.

Basal left coronary angiography in right oblique cranial view (A), showing two separated lesions, located in mid and distal LAD artery; proximal LAD is only mildly diseased, as better evident in right oblique caudal view (B, arrow), which reveals also a long critical stenosis of the most developed proximal OM branch. In C, this last stenosis has been treated with two overlapped EES implantation. In D, two other EES (arrows) have been implanted in LAD (see text for abbreviations and interventions timing)

Fig. 2.

Upper concavity ST-elevation during rest angina, extended to all the anterior ECG leads

Fig. 3.

Coronary angiography showing a proximal LAD haziness (black arrow) and diffuse spasms of not stented segments (white arrows) (A). The spasms were promptly resolved after intracoronary nitrates administration (B)

Fig. 4.

Intravascular ultrasound image of proximal LAD: minimal lumen area is 8.62 mm²

Fig. 5.

Direct implantation of a XIENCE V everolimus-eluting stent in proximal LAD (A) and angiographic result (B)

Fig. 6.

Trend of non-stented LAD segments diameter variations, as measured at the same level by QCA in different phases: 1. basal, at the time of effort angina; 2. soon after two separated EES, implanted in middle and distal LAD, respectively; 3. in course of spontaneous angina; 4. soon after intracoronary nitrates administration (see text for abbreviations and interventions timing)