Preserved endothelial vasomotion and fibrinolytic function in patients with acute stent thrombosis or in-stent restenosis.

Abstract

INTRODUCTION:

Acute stent thrombosis and in-stent restenosis are serious complications of percutaneous coronary intervention (PCI) and may be associated with vascular or platelet abnormalities. We aimed to assess endothelium-dependent vasomotion, endogenous fibrinolysis and platelet function in patients with acute stent thrombosis or in-stent restenosis.

MATERIALS AND METHODS:

Thirty-six subjects were enrolled into four groups: acute stent thrombosis, in-stent restenosis, uncomplicated PCI with stent implantation and healthy matched controls. Forearm blood flow was measured using bilateral venous occlusion plethysmography during intra-brachial acetylcholine, substance P and sodium nitroprusside infusion. Venous blood samples were withdrawn for estimation of plasma fibrinolytic variables and platelet aggregometry.

RESULTS:

Acetylcholine, substance P and sodium nitroprusside caused dose-dependent increases in blood flow (P < 0.001) and substance P caused a dose-dependent increase in tissue-type plasminogen activator (t-PA) release (P < 0.001) in all groups. Thrombin, collagen, adenosine diphosphate (ADP) and the thromboxane A2 analogue, U46619, caused dose-dependent platelet aggregation (P < 0.001) in all groups. There were no significant between group differences in these responses except that, in keeping with aspirin therapy, collagen-induced platelet aggregation was impaired in patient groups compared with healthy controls (P < 0.01). Post-hoc analysis demonstrated a significant impairment of acute t-PA release in current smokers compared to non-smokers (P < 0.05).

CONCLUSIONS:

Despite previous reports suggesting impaired vascular function, endothelium-dependent vasomotion, endogenous fibrinolysis and platelet aggregation do not appear to play a major role in the pathogenesis of acute stent thrombosis or in-stent restenosis.

• Authors: Stanley Chia, Ian L Megson, Christopher A Ludlam, Keith A Fox, David E Newby
• Journal: Thrombosis research (Thromb Res) Vol. 111 Issue 6 Pg. 343-9 ( 2003) ISSN: 0049-3848 [Print] United States
• PMID: 14698651 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Nitroprusside
• Substance P
• Acetylcholine

Topics

• Acetylcholine (therapeutic use)
• Aged
• Case-Control Studies
• Coronary Restenosis (etiology, prevention & control)
• Coronary Thrombosis (etiology, prevention & control)
• Endothelium, Vascular (drug effects, physiology)
• Female
• Fibrinolysis (drug effects, physiology)
• Humans
• Male
• Middle Aged
• Nitroprusside (therapeutic use)
• Platelet Aggregation (drug effects, physiology)
• Regional Blood Flow (drug effects)
• Stents (adverse effects)
• Substance P (therapeutic use)