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The First-Generation Drug-Eluting Stents and Coronary Endothelial Dysfunction

Lakshmana K. Pendyala, MD^_*, Xinhua Yin, MD, PhD, Jinsheng Li, MD, PhD, Jack P. Chen, MD, Nicolas Chronos, MD, Dongming Hou, MD, PhD^,_*

^_* Department of Cardiology, University of Louisville, Louisville, Kentucky
Saint Joseph's Research Institute, Saint Joseph's Hospital of Atlanta, Atlanta, Georgia

^_* Reprint requests and correspondence: Dr. Dongming Hou, Saint Joseph's Translational Research Institute, Saint Joseph's Hospital of Atlanta, 5673 Peachtree Dunwoody Road N.E., Suite 675, Atlanta, Georgia 30342 (Email: dhou{at}sjha.org).

Recently, a growing body of clinical data has shown that the first generation of drug-eluting stents (1st-gen DES) implantation could elicit coronary conduit artery vasomotor dysfunction at nonstented reference segments as late as 12 months after implantation compared with that seen with bare-metal stents. The mechanism of this phenomenon is still not fully understood. Pathological studies have implicated delayed arterial healing and poor re-endothelialization after the 1st-gen DES implantation. Given the vast use of DES globally, a thorough understanding of the early and long-term safety of these devices is paramount. Therefore, this article systematically reviews the current clinical, pathophysiological, and histopathological available data regarding 1st-gen DES-associated vascular endothelial dysfunction. Meanwhile, we will also review the newer generation of DES and emerging endothelial-friendly technology.

Key Words: drug-eluting stents • endothelial • vasomotor dysfunction

Abbreviations and Acronyms   Ach = acetylcholine   BES = biolimus-eluting stent(s)   BMS = bare-metal stent(s)   CAD = coronary artery disease   DES = drug-eluting stent(s)   EC = endothelial cell   ED = endothelial dysfunction   EES = everolimus-eluting stent(s)   eNOS = endothelial nitric oxide synthase   EPC = endothelial progenitor cell   ET = endothelin   IC = intracoronary   LST = late stent thrombosis   NO = nitric oxide   NSRS = nonstented reference segment(s)   PES = paclitaxel-eluting stent(s)   SES = sirolimus-eluting stent(s)   SMC = smooth muscle cell   ZES = zotarolimus-eluting stent(s)   1st-gen DES = first-generation drug-eluting stent

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