Combined therapeutic strategy to improve vascular endothelial function after implantation of sirolimus-eluting stents.

oronary arteries are readily blocked by atherosclerotic plaques, eventually triggering cardiovascular events (ie, ischemic coronary heart disease and myocardial infarction) in patients. Stent implantation is one strategy often used to attenuate the progression of coronary artery atherosclerosis and decrease cardiovascular-related mortality. Stents significantly reduce the risk rate of restenosis after percutaneous transluminal coronary angioplasty. Furthermore, the use of drug-eluting stents (DES), when compared with bare metal stents (BMS), results in a significantly decreased risk of in-stent restenosis, late stent thrombosis and vascular dysfunction. However, although the clinical effectiveness of diluted sirolimus-eluting stents (SES) is superior when compared with BMS, concerns have been raised regarding impaired vascular function after SES implantation. Although SES reduce vascular restenosis, which is characterized by vascular smooth muscle cell (VSMC) proliferation, migration, and an increased inflammatory response, this particular DES simultaneously impairs vascular endothelial function in humans,1 which is characterized by increased endothelial cell (EC) inflammation and impaired endothelial-dependent vasomotor function. The occurrence of abnormal endothelial function is problematic because endothelial dysregulation is a major determinant of atherosclerosis in the early pathophysiological stages and has been demonstrated to occur in patients with coronary artery disease, hypertension, and type 2 diabetes. Thus, strategies to improve EC function are being actively investigated in the field.