Evaluation and medical therapy for coronary endothelial dysfunction induced by sirolimus-eluting stent in patient with an atherosclerotic lesion of the left main coronary artery: Case report

Abstract Sirolimus-eluting stents (SES), especially those deployed at distal sites, cause more coronary vasospasm and endothelial dysfunction in the chronic phase compared to bare-metal stents (BMS). In comparison, endothelial dysfunction is less frequently induced by the Biolimus-A9 eluting stent (BES). A 75-year-old man with effort-induced angina pectoris previously underwent a total of three SES implantations in the left anterior descending coronary artery (LAD) and right coronary artery (RCA) in 2010 and 2011. He was referred to our hospital for the management of chest discomfort at rest in August 2014. We diagnosed this patient with coronary spastic angina (CSA) and coronary endothelial dysfunction (CED) induced by the SES, together with an atherosclerotic lesion in the left main coronary artery (LMCA). Adequate medication for CSA and CED and intervention for the atherosclerotic lesion contributed to improvement of vascular function and disappearance of his symptoms. Learning objective: The frequency of endothelial dysfunction induced by Biolimus-A9 eluting stents (BES) is less than that induced by Sirolimus-eluting stents (SES), although all drug-eluting stents are more likely to cause coronary vasospasm and endothelial dysfunction in the chronic phase, especially at distal deployment sites, as compared to bare-metal stents (BMS). Adequate medication for coronary spastic angina (CSA) and endothelial dysfunction, and interventions for atherosclerotic lesions are useful for improving vascular function and cardiac symptoms.>