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Endothelium-dependent coronary vasomotor response and neointimal coverage of zotarolimus-eluting stents 3 months after implantation
  1. Kenichi Fujii1,
  2. Daizo Kawasaki1,
  3. Katsumi Oka1,
  4. Hirokuni Akahori1,
  5. Masashi Fukunaga1,
  6. Hisashi Sawada1,
  7. Motomaru Masutani2,
  8. Masaaki Lee-Kawabata1,
  9. Takeshi Tsujino3,
  10. Mitsumasa Ohyanagi2,
  11. Tohru Masuyama1
  1. 1Cardiovascular Division, Hyogo College of Medicine, Nishinomiya, Japan
  2. 2Division of Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan
  3. 3Department of Pharmacy, Hyogo University of Health Sciences, Kobe, Japan
  1. Correspondence to Dr Kenichi Fujii, Hyogo College of Medicine, Cardiovascular Division, 1-1 Mukogawa-cho, Nishinomiya-city, Hyogo 6638501, Japan; kfujii{at}


Background Zotarolimus-eluting stents (ZES) have a higher rate of neointimal coverage than the first-generation drug-eluting stents on optical coherence tomography (OCT).

Objective To determine whether neointimal coverage of stent struts detected by OCT can be used as a surrogate for endothelial function after ZES implantation.

Design Cross-sectional observational study.

Setting Three months after ZES implantation.

Patients and methods OCT was performed in 20 patients with a ZES at 3 months after stent implantation to evaluate strut coverage. Endothelium-dependent coronary vasomotion was estimated by infusing incremental doses of acetylcholine into the coronary ostium. The vascular response was measured in the 10 mm segments proximal and distal to the stent.

Results Of 20 ZES, 15 (75%) were covered completely with neointima, but the remaining 5 ZES had exposed struts. The high-dose acetylcholine infusion produced significant vasoconstriction in the proximal (−9.8±10.1%) and the distal stent segment (−29.7±22.7%). However, the degree of vasoconstriction to acetylcholine varied between individuals (from −0.6% to −77%). Although no relationship was observed between coronary vasomotor response (percentage change in diameter after acetylcholine administration) and average neointimal thickness, the number of cross-sections with uncovered struts showed an inverse correlation with coronary vasomotor response in proximal and distal stent segments (r=−0.57, p=0.007 and r=−0.83, p<0.001, respectively).

Conclusions The existence of exposed struts was associated with abnormal vasoconstriction to acetylcholine at 3 months after ZES implantation. The findings suggest that complete neointimal coverage of stent struts assessed by OCT could be used as a surrogate for vasomotion impairment at 3 months after ZES implantation.

  • Drug-eluting stents
  • acetylcholine
  • optical coherence tomography
  • intravascular ultrasound
  • coronary stenting
  • coronary vasomotion

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  • See Editorial, p 953

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Hyogo College of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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