Korean Circ J.  2008 Mar;38(3):174-178. 10.4070/kcj.2008.38.3.174.

A Case of Late Recurrent Vasospasm After Sirolimus-Eluting Stent Implantation

• Lee TK
• Lee HC
• Hwang KW
• Chun KJ
• Hong TJ
• Shin YW

• KMID: 2225835
• DOI: http://doi.org/10.4070/kcj.2008.38.3.174

Abstract

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 zotarolimus-eluting 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.

Keyword

Coronary vasospasm; Endothelium, vascular; Drug-eluting stent

MeSH Terms

Aged
Angina, Stable
Arteries
Chest Pain
Coronary Angiography
Coronary Artery Disease
Coronary Vasospasm
Diabetes Mellitus
Drug-Eluting Stents
Emergencies
Endothelium, Vascular
Humans
Hypertension
Male
Myocardial Infarction
Phenobarbital
Phosphorylcholine
Polymers
Sirolimus
Smoke
Smoking
Stents
Stroke
Phenobarbital
Phosphorylcholine
Polymers
Sirolimus
Smoke

Figure

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  Fig. 1 Angiogram of the left anterior descending artery. It shows a diffuse long stenotic lesion before (A) and immediately after (B) sirolimus-eluting stent placement.

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  Fig. 2 Angiogram and electrocardiography after 17 months. Diffuse luminal narrowing distal to the m-LAD stent site (A) and electrocardiographic findings (B). m-LAD: mid left anterior descending artery.

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  Fig. 3 Coronary angiogram after intracoronary nitroglycerin. It quickly resolved the angiographic diffuse luminal narrowing distal to the m-LAD stent site. m-LAD: mid left anterior descending artery.

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  Fig. 4 Electrocardiographic findings when vasospastic myocardial infarction developed.

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  Fig. 5 Coronary angiography after infarction. Zotarolimus-eluting stent implantation (A) and the final angiographic result (B).

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