Delayed severe multivessel spasm and aborted sudden death after Taxus stent implantation

Abstract

Sudden cardiac arrest associated with major spasm of three coronary arteries was observed about 10 hours after Taxus stent insertion in a three vessel lesion and was successfully treated by intracoronary glyceryl trinitrate infusion. This case illustrates a potential risk associated with drug eluting stent and alerts clinicians to the life threatening risk of spasm when stenting multiple vessels with drug eluting stent (especially the Taxus stent).A 62 year old woman was referred for acute chest pain. ECG and an echocardiogram showed acute inferior myocardial infarction. Coronary angiography showed a total occlusion of the proximal right coronary artery and significant focal stenosis in the mid left anterior descending artery and the proximal left circumflex artery (fig 1). Taxus stents (slow release, polymer based, paclitaxel eluting Express stent, Boston Scientific, Natick, Massachusetts, USA) measuring 3.5 6 28 mm, 3.0 6 24 mm, and 3.5 6 16 mm were successfully implanted in the right coronary artery, left anterior descending artery, and left circumflex artery lesions, respectively, after mandatory predilatation. The patient had been treated with calcium channel antagonist and oral nitrate. Ten hours after the procedure, sudden cardiac arrest developed and advanced cardiac life support was performed. Emergency repeated coronary angiography showed severe diffuse narrowing of three coronary arteries except for the previously implanted stent sites (fig 2). Severe

Coronary vasomotion dysfunction after everolimus-eluting stent implantation

“…The regional involvement should lead to exclude any systemic infl ammatory process but rather suggests a local hypersensitive reaction, possibly related to each of the DES components (metallic platform, polymer coating, or eluted drug). At this regard, we hypothesize that the metallic platform is the less probable responsible element, given the large number of BMS implanted worldwide in absence of recurrent coronary spasms [2]. We are, rather, hypothesizing an important role of the eluted drug, which is the same in all the implanted DES.…”

“…First generation sirolimus and paclitaxel-eluting stents can cause "in-segment" paradoxical coronary vasoconstriction (PCV) [1,2]. This phenomenon has been specifi cally drug-eluting stent (DES) related, and, more recently, it has been also reported with zotarolimus (ZES) [3].…”

Inhibition of Ribonucleotide Reductase Reduces Neointimal Formation following Balloon Injury

“…Although the incidence of restenosis has markedly decreased with the advent of drugcoated stents, restenosis still occurs in up to 20% of patients within the first year, whereas results on late lumen loss are still being gathered (Drachman et al, 2000;Heldman et al, 2001;Grube et al, 2003;Kastrati et al, 2005;Kim et al, 2005). In addition, because the use of coated stents may increase the risk of thrombosis, there is a need for agents that can be administered systemically in patients at high risk for thrombotic events (Morice, 2005).…”

THE INHIBITORY EFFECT OF PACLITAXEL ON (KV2.1) K⁺ CURRENT IN H9c2 CELLS

“…Depolarization of the pulmonary blood vessel at the atrial boundary region might also trigger arrhythmia. A significant focal stenosis was reported in the coronary artery treated with a paclitaxel -eluting stent 25) . There may be a relation between the depolarization of arterial smooth muscle by paclitaxel and facilitating arterial stenosis.…”