Accelerated atherosclerosis following intracoronary haematopoietic stem cell administration

Haematopoietic stem cell therapy is emerging as a promising treatment for patients with left ventricular (LV) dysfunction after acute myocardial infarction. However, recent experimental and clinical data suggest accelerated atherosclerosis occurs following bone marrow mobilisation or intracoronary haematopoietic stem cell therapy. We report on a 74 year old man with acute anterior myocardial infarction treated with primary percutaneous coronary intervention and stenting of the proximal left anterior descending coronary artery (LAD) with a paclitaxel eluting stent (Taxus, Boston Scientific, panel A). Selected haematopoietic CD133⁺ cells were administered intracoronarily seven days later. Follow up coronary angiography at four months showed no restenosis at the site of the stenting. In contrast, a critical mid LAD lesion, associated with a significant decrease in the myocardial fractional flow reserve, was noted distal to the stent (panel B). LV ejection fraction showed a mild increase from 46% to 51% at follow up angiography.

Accelerated atherosclerosis following intracoronary stem cell therapy may cloud myocardial recovery and requires careful assessment in further studies.

Baseline coronary angiogram before CD133⁺ cell injection. Multiple arrows indicate diffuse atherosclerosis in the mid LAD distal to the stent deployment. FFR, myocardial fractional flow reserve; LAD, left anterior descending coronary artery; CX, left circumflex coronary artery.

Upper panel shows coronary angiography at four months follow up. Arrows indicate mid LAD with the progression of the coronary atherosclerosis with de novo critical lesion. Lower panel shows pressure measurements with myocardial fractional flow reserve. Pao, aortic pressure; Pc, distal coronary pressure.