Impacto dos stents e do sirolimus por via oral na vasomotilidade coronariana dependente e independente do endotelio

• Autor(a) principal: Fernandes, Rósley Weber Alvarenga [UNIFESP]
• Data de Publicação: 2012
• Outros Autores: Dantas, João Miguel [UNIFESP], Oliveira, Dinaldo Cavalcanti [UNIFESP], Bezerra, Hiram Grando [UNIFESP], Brito Jr., Fabio Sandoli [UNIFESP], Lima, Valter C. [UNIFESP]
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://dx.doi.org/10.1590/S0066-782X2012005000022; http://repositorio.unifesp.br/handle/11600/7047
• topic: Stents; coronary vessels; endothelium; sirolimus; Stents; vasos coronarianos; endotélio; sirolimus

BACKGROUND: There is no consensus regarding the impact of stenting on long-term endothelial function. There have been reports of increased endothelial dysfunction with sirolimus-eluting stents as compared to bare metal stenting (BMS). OBJECTIVE: This study aims to assess the impact of BMS and the effect of oral sirolimus on endothelial function. METHODS: Forty-five patients were randomized into three groups: BMS + high-dose oral sirolimus (initial dose of 15 mg, followed by 6 mg/day for four weeks); BMS + low-dose sirolimus (6 mg followed by 2 mg daily for four weeks); and BMS without sirolimus. Changes in vasoconstriction or vasodilation in a 15 mm segment starting at the distal stent end in response to acetylcholine and nitroglycerin were assessed by quantitative angiography. RESULTS: The groups had similar angiographic characteristics. The percent variation in diameter in response to acetylcholine was similar in all groups at the two time points (p = 0.469). Four hours after stenting, the target segment presented an endothelial dysfunction that was maintained after eight months in all groups. In all groups, endothelium-independent vasomotion in response to nitroglycerin was similar at four hours and eight months, with increased target segment diameter after nitroglycerin infusion (p = 0.001). CONCLUSION: The endothelial dysfunction was similarly present at the 15 mm segment distal to the treated segment, at 4 hours and 8 months after stenting. Sirolimus administered orally during 4 weeks to prevent restenosis did not affect the status of endothelium-dependent and independent vasomotion.