Cypher与Taxus支架治疗冠心病的冠状动脉造影随访结果

目的观察Cypher及Taxus药物洗脱支架治疗冠心病的疗效。方法应用冠状动脉造影随访162例接受Cypher及Taxus药物洗脱支架置入术的冠心病患者,其中Cypher组93例,Taxus组69例。结果Cypher组和Taxus组再狭窄率分别为10.8%和11.6%,靶病变再血管化率分别为5.4%和5.8%,两组比较差异均无统计学意义。支架内晚期管径丢失及支架节段晚期管径丢失在Cypher组低于Taxus组,两组间差异有统计学意义。结论药物洗脱支架可有效降低介入治疗术后再狭窄的发生率,但Cypher组支架内晚期管径丢失低于Taxus组。     

冠状动脉长病变串联置入雷帕霉素和紫杉醇洗脱支架重叠部分对分支血管影响的比较

目的 回顾性分析对于冠状动脉长病变串联置入雷帕霉素洗脱支架(Cypher)与紫杉醇洗脱支架(TAXUS)时,支架的重叠部分对直径<2.0 mm的分支血管的影响.方法 回顾2004年1月至2007年10月间在北京协和医院行择期经皮冠状动脉介入治疗(PCI)且至少有1支靶血管进行了串联置入药物洗脱支架的141例患者的光盘和临床资料,排除急性心肌梗死和急性冠状动脉综合征的患者.按照置入药物洗脱支架的种类分为Cypher组和TAXUS组,对比分析两种不同的药物洗脱支架串联置入时重叠部分对直径<2.0 mm的分支血管血流的影响.结果 共有141例患者人选,其中男性115例,女性26例.共置入支架297枚,累及分支血管154支.其中Cypher支架组入选83例,TAXUS支架组入选58例.PCI术后支架重叠部位分支血管的闭塞率Cypher支架组为24.6%,TAXUS支架组为31.6%;支架重叠部位分支血管血流减慢Cypher支架组为26.3%,TAXUS支架组为68.4%.两组差异无统计学意义.多种因素回归分析结果表明:分支血管直径、分支血管开口狭窄是分支血管闭塞的独立危险因素.结论 与TAXUS组相比,Cypher组支架重叠部位较少引起分支血管闭塞,但两者差异无统计学意义.分支血管开口狭窄和分支血管直径是影响支架重叠部位分支血管闭塞的主要因素.     

冠心病分叉病变不同处理方法疗效研究

目的 探讨应用药物支架治疗冠心病分叉病变时对开口狭窄的分支血管不同处理方法的疗效.方法 入选66例主支血管药物支架置入术后引起直径≥2.0mm且＜2.5mm分支血管开口狭窄大于50%的、于术后6～12个月间接受冠状动脉造影随访的患者,根据分支血管采取的不同治疗方法分成2组,即主支置入支架、分支血管单纯球囊扩张组(球囊扩张组)和主支置入支架、分支未处理组(未处理组).观察分支血管开口狭窄程度变化及主要不良心血管事件发生情况.结果 于术后6～12个月接受冠状动脉造影复查随访时,虽然分支开口狭窄程度在球囊扩张组优于未处理组,但两组间主支血管再狭窄率和主要不良心血管事件发生率差异无统计学意义(P＞0.05).结论 对支架置入后开口狭窄的分支血管采取单纯球囊扩张治疗并没有改善远期临床预后.     

药物洗脱支架和普通金属支架对分支血管影响的对比研究

目的观察冠状动脉雷帕霉素洗脱支架置入对直径小于2.5mm分支血管的影响。方法选取2002年5月至2004年5月在上海交通大学医学院附属瑞金医院行CypherTM药物洗脱支架和BXVelocityTM普通金属支架置入术的648例患者为研究对象,记录患者冠心病危险因子和冠状动脉病变特征,对比分析两种支架置入对直径小于2.5mm分支血管的影响,并观察患者手术前后血清C反应蛋白和肌钙蛋白变化。结果与普通金属支架组比较,药物洗脱支架组置入支架较长,但两组支架置入后分支闭塞发生率相似。进一步分析支架置入血管狭窄≥90%、分支血管开口处≥50%狭窄538支闭塞高危分支血管,发现药物洗脱支架组(n=259)较普通金属支架组(n=279)支架置入后分支闭塞发生率高(18.5%对16.12%),但差异无显著性意义。结论冠状动脉病变药物洗脱支架置入导致直径小于2.5mm分支血管闭塞发生率与普通金属支架置入相似。     

药物洗脱支架和普通支架导致直径小于 2.5 mm分支血管闭塞的对比研究

目的观察冠状动脉药物洗脱支架置入对直径小于2.5mm分支血管的影响.方法记录冠心病危险因子和冠状动脉病变特征,对比分析药物洗脱支架和普通支架置入对直径小于2.5 mm分支血管的影响,并观察患者手术前后血清C反应蛋白和肌钙蛋白T变化结果648例患者783处病变共置入支架917枚,累及直径小于2.5 mm分支血管1 256支,其中药物支架组584支,普通支架组672支.与普通支架组比较,药物支架组置入支架较长,但两组支架置入后分支闭塞发生率相似.进一步分析支架置入血管狭窄≥90%、分支血管开口处≥50%狭窄的826支分支血管,发现药物支架组(369支)较普通支架组(457支)支架置入后分支闭塞发生率较高(48支和45支),但无显著性差异.结论药物洗脱支架较普通支架置入易导致直径小于2.5 mm分支血管闭塞,但未达统计学差异.     

分叉病变不同处理方法的疗效观察

目的观察比较应用药物支架治疗分叉病变时对开口狭窄的分支血管的不同处理方法(即支架治疗、单纯球囊扩张和不处理分支)的疗效。方法入选93例主支血管药物支架置入术后引起直径≥2.0mm分支血管开口狭窄大于50%的、于术后6~12个月间接受冠状动脉造影随访的患者,根据分支血管采取的不同治疗方法分成3组,即主支和分支血管均置入支架组(简称支架组)、主支置入支架、分支血管单纯球囊扩张组(简称球囊扩张组)和主支置入支架、分支未处理组(简称未处理组)。观察分支血管开口狭窄程度变化及主要不良心血管事件发生情况。结果于术后6~12个月接受冠状动脉造影复查随访时,虽然分支开口狭窄程度在支架组和球囊扩张组仍优于未处理组(三组分别为40.21%,40.76%和80.23%;P<0.001),但三组间主支血管再狭窄率和主要不良心血管事件发生率差异无统计学意义(三组主支血管再狭窄率分别为33.33%,25.00%和12.50%;P=0.085;主要不良心血管事件发生率分别为38.10%,29.17%和25.00%;P=0.523)。结论对支架置入后开口狭窄的分支血管采取积极的处理方法(如支架置入、单纯球囊扩张)同未处理组相比,并没有改善远期临床预后。     

完全闭塞性冠脉血管成形术中冠脉内支架的应用及其限制因素

目的　评价冠状动脉（冠脉）内支架在完全闭塞性冠脉血管成形术（ＰＴＣＡ）中应用的指征及其限制因素。方法　８２ 例冠脉完全闭塞接受ＰＴＣＡ 患者,根据血管病变性质,决定是否给予置入支架治疗。分析支架应用的指征及其限制因素。术后随访６ 个月,发生心脏事件者行血管造影复查。结果　８２例中,６６ 例相关冠脉再通成功,成功率为８０．５％ 。６６ 例中,Ａ 组２３ 处病变单纯球囊ＰＴＣＡ 后取得“支架样”效果,其中Ｂ１ 组３０ 处病变置入支架,支架置入率４５．５％ ,Ｂ２ 组１３ 处病变存在支架置入的限制因素而未置入支架,占１９．７％ 。临床随访期间,Ａ 组５ 例发生心脏事件,血管造影复查,２ 例再狭窄;Ｂ１ 组仅２例发生心脏事件,造影复查２ 例均再狭窄,需再次ＰＴＣＡ;Ｂ２ 组 ５ 例发生心脏事件,３ 例造影发现再狭窄。闭塞冠脉再通未成功１６ 例中３ 例出现心脏事件,其中１ 例死亡。结论　闭塞冠脉再通成功达支架样效果或置入支架有助于改善临床预后,但部分病变存在支架置入的限制因素,不适宜置入支架     

药物洗脱支架治疗完全闭塞病变的疗效观察

目的:评估在冠心病患者,不同药物洗脱支架对于治疗冠状动脉完全闭塞病变的远期疗效。方法:122例完全闭塞病变[冠状动脉溶栓治疗临床试验(TIMI)0级血流,且闭塞时间>3个月]并成功置入Firebird支架(Firebird组,n=58)、Cypher支架(Cypher组,n=40)和Taxus支架(Taxus组,n=24)的患者入选本研究。术后12个月随访时进行定量冠状动脉造影分析,并观察住院期间,30天和12个月时不良心脏事件的发生和靶病变重复血管重建。结果:3组的基本临床特征和基础冠状动脉造影结果相似,支架置入成功率均为100。术后支架内最小管腔直径,3组间差异无统计学意义(P>0.05)。住院期间3组均无靶病变重复血管重建和死亡发生。在30天时,3组均无支架内血栓形成。12个月随访期间,严重不良心脏事件发生率和靶病变重复血管重建率,在Firebird组为5.2和3.4;Cy-pher组为10.0和5.0,其中死亡1例(2.5);Taxus组为12.5和12.5,均无显著性差异(P>0.05)。12个月定量冠状动脉造影分析显示:支架内最小管腔直径和管腔狭窄直经,在Firebird组和Cypher组无显著差...     

西罗莫司和紫杉醇洗脱支架治疗支架内再狭窄的临床近期及10个月疗效

目的比较西罗莫司洗脱支架（Cypher或Cypher select）和紫杉醇洗脱支架（TAXUS）治疗支架内再狭窄的临床近期及10个月疗效。方法自2002年12月至2005年3月,对253例支架内再狭窄的患者采用了药物洗脱支架（DES）治疗并完成了10个月的临床随访和冠状动脉造影复查。253例中男性218例,女性35例,年龄30～80岁,平均年龄57．2岁。结果253例（262处病变）中152例使用Cypher支架176个,101例使用TAXUS支架132个。使用的Cypher和TAXUS支架的平均直径分别为（2．96±0．27）mm和（3．05±0,35）mm,P=0．04,平均长度分别为（23.31±6．68）mm和（23．56±6．54）mm,P=0．745。支架内再狭窄表现为100％闭塞29处,≥90％狭窄143处,〈90％狭窄90处。病变类型为A、B1、B2和C型各为9处、45处、73处和135处。PCI的成功率两组均为100％,住院期间无死亡,Cypher组主要心脏不良事件（MACE）发生率为2．63％,TAXUS组为2．97％,P=0．872。10个月临床造影显示在Cypher支架和TAXUS支架组中造影再狭窄率分别为14．0％和29．4％,P=0．075,MACE发生率分别为6．7％和16．0％,P=0．031。结论应用Cypher和TAXUS支架治疗支架内再狭窄有良好的近期临床疗效,10个月疗效Cypher支架优于TAXUS支架。     

尿激酶溶栓联合介入术治疗急性脑梗死51例

目的评价急性脑梗死动脉内溶栓结合动脉溶栓后残余狭窄球囊扩张、支架置入术治疗的疗效。方法 51例急性脑梗死病人采取超选择接触性溶栓,尿激酶(UK)用微量泵以1×104U/min持续泵入,总量为60×104U～100×104U。在泵入尿激酶的过程中,通过导引导管造影,了解闭塞血管再通情况。结果颈动脉系统血管闭塞43例,椎-基底动脉系统闭塞2例。脑血管造影未发现明显的血管闭塞6例。颈内动脉闭塞再通率为63.64%;大脑中动脉闭塞再通率为63.63%;大脑中动脉分支闭塞再通率为55.56%;大脑前动脉闭塞(前交通动脉未开放)的1例再通;椎-基底动脉系统闭塞2例全部部分再通。动脉溶栓后颈内动脉残余明显狭窄3例行球囊扩张支架置入术。临床症状完全恢复正常或有明显好转的33例(64.71%)。结论动脉内接触性溶栓结合动脉溶栓后残余狭窄球囊扩张、支架置入术治疗急性脑梗死能明显提高治愈率,减少致残率,是安全、可靠、有效的治疗方法。     

Drug‐eluting stents in bifurcation lesions: To stent one branch or both?

OBJECTIVES: The objective of this study was to compare two techniques to treat bifurcation lesions: a single drug-eluting stent (DES) implanted in the main branch combined with balloon dilatation for the side branch vs. stenting of both branches (double stent). BACKGROUND: Percutaneous coronary intervention in coronary bifurcation lesions remains challenging. Although DES reduce restenosis in lesions, the double stent procedure has not shown clear advantages over a single stent with balloon dilation. METHODS: Fifty-three symptomatic patients with true bifurcation lesions were treated using either the double stent technique (n = 25) or one stent in the parent vessel plus balloon angioplasty of the side branch (n = 28). Procedural results and major adverse cardiac event rates (MACE: cardiac death, myocardial infarction, target vessel revascularization (TVR)) were compared. RESULTS: Angiographic procedural success (residual stenosis <30% in both branches) was 75% in the single stent group and 100% in the double stent group (P = 0.01). All differences were due to residual stenosis of the side branch. Clinical follow-up (6-18 months) was available for all patients; 90.5% of patients had a coronary angiography or nuclear stress test. Three patients (11%) in the single stent group and two (8%) in the double stent group had ischemia-driven TVR (P = NS). Asymptomatic angiographic restenosis (>50% diameter stenosis) in the ostium of the side branch was seen in two patients in the double-stent group. At 6 months, MACE-free was comparable between groups (89.3% vs. 88%, P = 0.7). CONCLUSIONS: When treating bifurcation lesions with sirolimus-eluting stents, restenosis following a single stent procedure is comparable to stenting both parent and side branch vessels. Thus, stenting the main-branch lesion, coupled with balloon angioplasty in the side branch, produces a high success rate and good clinical outcomes at 6 months.     

Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk.

OBJECTIVES: This study examined human drug-eluting stents (DES) to determine the long-term effects of these stents on coronary arterial healing and identified mechanisms underlying late stent thrombosis (LST). BACKGROUND: Although DES reduce the need for repeat revascularization compared with bare-metal stents (BMS), data suggest the window of thrombotic risk for Cypher (Cordis Corp., Miami Lakes, Florida) and Taxus (Boston Scientific Corp., Natick, Massachusetts) DES extends far beyond that for BMS. METHODS: From a registry of 40 autopsies of DES (68 stents), 23 DES cases of >30 days duration were compared with 25 matched autopsies of BMS implantation. Late stent thrombosis was defined as an acute thrombus within a stent >30 days old. RESULTS: Of 23 patients with DES >30 days old, 14 had evidence of LST. Cypher and Taxus DES showed greater delayed healing characterized by persistent fibrin deposition (fibrin score 2.3 +/- 1.1 vs. 0.9 +/- 0.8, p = 0.0001) and poorer endothelialization (55.8 +/- 26.5%) compared with BMS (89.8 +/- 20.9, p = 0.0001). Moreover, DES with LST showed more delayed healing compared with patent DES. In 5 of 14 patients suffering LST, antiplatelet therapy had been withdrawn. Additional procedural and pathologic risk factors for LST were: 1) local hypersensitivity reaction; 2) ostial and/or bifurcation stenting; 3) malapposition/incomplete apposition; 4) restenosis; and 5) strut penetration into a necrotic core. CONCLUSIONS: The Cypher and Taxus DES result in delayed arterial healing when compared with BMS of similar implant duration. The cause of DES LST is multifactorial with delayed healing in combination with other clinical and procedural risk factors playing a role.     

Drug-eluting Stents bei Patienten mit Diabetes mellitus

BACKGROUND AND PURPOSE: Patients with coronary artery disease (CAD) and diabetes mellitus represent a peculiar high-risk population because of their specific characteristics of atherosclerotic disease. In conjunction with the diabetes-related comorbidities, percutaneous coronary intervention (PCI) often leads not only to a worse acute result but - also as compared to nondiabetics - to significantly worse long-term results due to the higher restenosis rates. The rapid introduction of effective drug-eluting stents (DES), which undoubtedly reduce the restenosis rates as compared with bare-metal stents (BMS), brought great hope of providing diabetic patients better and longer-lasting interventional solutions. This overview compiles the currently available data from randomized trials and meta-analyses. METHODS: Altogether, 86 randomized DES studies were identified in 34,677 patients. None of these with an adequate primary clinical endpoint had diabetes as an inclusion criterion. The high standard of an adequate primary clinical endpoint for comparing BMS versus DES in patients with predominantly stable CAD and de novo lesions was met by only five pivotal trials: SIRIUS (Cypher stent), TAXUS-IV, -V, -VI (Taxus stent) and ENDEAVOR II (Endeavor stent). Patients with diabetes were represented in these trials only in smaller subgroups. Three studies with a primary surrogate endpoint had diabetes as an inclusion criterion (DIABETES, SCORPIUS and ISAR-DIABETES, totaling 610 patients). The efficacy parameter TLR (target lesion revascularization) was chosen to compare these studies and the subgroup analyses. RESULTS: In the subgroup analyses for diabetic patients in the pivotal trials, TLR was reduced at the time of the primary endpoint after 9 months as compared with BMS as follows (p < 0.05): Cypher stent (279 patients): 22.3% versus 6.9%; Taxus stent (318 patients): 16.0% versus 5.2%; Endeavor stent (239 patients): 15.2% versus 7.5%. 5-year follow-up data are available only for the Cypher and Taxus stents with 33.1% versus 13.7% and 26.9% versus 13.4%. As compared with BMS, the three above-mentioned studies studies with a primary surrogate endpoint and diabetes as an inclusion criterion showed a significant reduction of TLR after 9 months of 31.3% versus 7.3% and after 8 months of 25.0% versus 5.3%, respectively. The TLR between Taxus (12.0%) and Cypher (6.4%), however, was not statistically different. Meta-analyses of 627 Cypher patients and 814 Taxus patients corroborated these findings with 1-year TLR of 24.8% versus 7.9% and 20.5% versus 8.0%. CONCLUSION: Of the 22 DES having received a CE certificate, long-term data over 5 years for patients with diabetes are available only for the Cypher and the Taxus stents. Compared with BMS, patients with diabetes and their characteristically small vessels and long lesions predominantly benefit from effective DES. The sometimes postulated differences between Cypher and Taxus in diabetic patients could not be convincingly demonstrated; larger randomized trials with a primary clinical endpoint are required for this. PCI cannot be considered a scientifically sound and evidence- based alternative to bypass surgery in diabetic patients with multivessel disease and/or unprotected left main stenosis until we have the results of the SYNTAX, COMBAT and FREEDOM trials.     

药物洗脱支架治疗冠状动脉小血管病变的疗效分析

目的通过分析比较裸金属支架(BMS)与药物洗脱支架[DES,包括雷帕霉素(Cypher)支架和紫杉醇(TAXUS)支架]治疗冠状动脉小血管病变疗效的差异,为DES治疗多支及单支小血管病变冠心病提供依据。方法连续入选2002年12月至2005年5月沈阳军区总医院首次接受经皮冠状动脉介入治疗(PCI)、靶血管为小血管病变且达到完全血运重建的486例患者,其中多支小血管病变(多支)150例。分为BMS组214例(多支63例)、Cypher组140例(多支46例)和TAXUS组132例(多支41例),对比分析各组患者住院期间及随访6个月的临床情况。结果3组患者冠脉病变特点、PCI成功率及住院期间主要不良心脏事件(MACE)发生率等指标差异均无显著性(P>0·05)。冠脉造影随访显示,两个DES组再狭窄率均明显低于BMS(Cypher组4·9%,TAXUS组7·5%对BMS组29·2%,P<0·05),随访期间MACE发生率亦明显低于BMS(Cypher组2·9%,TAXUS组3·9%对BMS组12·0%,P<0·01)。进一步分析多支小血管病例,发现两个DES组的再狭窄率及随访期间MACE发生率仍然明显低于BMS组(再狭窄率Cypher组6·7%,TAXUS组7·1%对BMS组37·5%,P<0·05;MACE发生率Cypher组4·1%,TAXUS组4·8%对BMS组21·0%,P<0·05)。结论Cypher和TAXUS支架治疗小血管病变安全可行,疗效显著,治疗多支小血管病变可得到相同的疗效。     

Combining stenting with the double wire technique effectively prevents side branch occlusion

Coronary angioplasty involves a high occlusive risk for side branches originating just before, within or behind the dilated stenosis. We retrospectively investigated a new technique combining stenting of the main vessel with protection of the side branch with an inserted second wire, placed between the stent and the wall of the main vessel. From 86 patients undergoing this procedure in our hospital, the side branch remained open in 78 patients (91%). Eight patients initially had a relevant partial or complete occlusion of the protected side branch after stenting. In 5 of these patients, the occlusion could be re-opened at once by angioplasty. In the other 3, TIMI flow was 1 or 2 in the side branch. One of these patients developed an additional thrombotic occlusion of the main vessel (RCA) causing Q-wave infarction. In one other patient, the side branch occlusion caused a mild elevation of creatin kinase. In summary, combining the double wire technique with stenting is safe and effective to protect side branches during coronary angioplasty.     

In‐hospital and nine‐month outcomes among patients with coronary lesions involving a side branch and treated with bare metal stents

Background : The optimal management of coronary lesions involving side branches is not known. New devices are being developed for dedicated bifurcation stenting or improved side branch access or protection. Several of these devices are bare‐metal stent (BMS) platforms. The risk of side branch compromise and outcome after standard BMS is not known. Methods : We evaluated the frequency of side branch involvement and the rate of side branch compromise in a retrospective analysis of 1,440 patients from three pooled historical BMS clinical trials. The impact of side branch compromise on in‐hospital and nine‐month clinical outcomes was assessed. Results : Side branches >2 mm in diameter were present within the stented segment in 39% of treated lesions. Compromise of a side branch occurred in 27% of 1,440 lesions, including 22% of side branches that were not diseased prior to stenting. Compromise was associated with increased in‐hospital MI (13.5% vs. 7.6%, P = 0.001), a trend for increased nine‐month clinically driven target vessel revascularization (TVR, 17.4% vs. 13.2%, P = 0.058), and increased nine‐month target vessel failure (composite of cardiac death, target vessel MI or TVR, 29.7% vs. 20.2%, P < 0.001). Conclusion : At least moderate‐sized side branches are involved frequently in lesions enrolled in routine clinical trials. Unexpected compromise of these side branches is common and is associated with increased in‐hospital and nine‐month adverse outcomes. © 2010 Wiley‐Liss, Inc.     

Coronary collateral function long after drug-eluting stent implantation.

OBJECTIVES: This study was designed to compare coronary collateral function in patients after bare-metal stent (BMS) or drug-eluting stent (DES) implantation. BACKGROUND: Drug-eluting stents have an inhibitory effect on the production of cytokines, chemotactic proteins, and growth factors, and may therefore negatively affect coronary collateral growth. METHODS: A total of 120 patients with long-term stable coronary artery disease (CAD) after stent implantation were included. Both the BMS group and the DES group comprised 60 patients matched for in-stent stenosis severity of the vessel undergoing collateral flow index (CFI) measurement at follow-up and for the duration of follow-up. The primary end point of the investigation was invasively determined coronary collateral function 6 months after stent implantation. Collateral function was assessed by simultaneous aortic, coronary wedge, and central venous pressure measurements (yielding CFI) and by intracoronary electrocardiogram during balloon occlusion. RESULTS: There were no differences between the groups regarding age, gender, body mass index, frequency of cardiovascular risk factors, use of cardiovascular drugs, severity of CAD, or site of coronary artery stenoses. Despite equal in-stent stenosis severity (46 +/- 34% and 45 +/- 36%) and equal follow-up duration (6.2 +/- 10 months and 6.5 +/- 5.4 months), CFI was diminished in the DES versus BMS group (0.154 +/- 0.097 vs. 0.224 +/- 0.142; p = 0.0049), and the rate of collaterals insufficient to prevent ischemia during occlusion (intracoronary electrocardiographic ST-segment elevation > or =0.1 mV) was higher with 50 of 60 patients in the DES group and 33 of 60 patients in the BMS group (p = 0.001). CONCLUSIONS: Collateral function long after coronary stenting is impaired with DES (sirolimus and paclitaxel) when compared with BMS. Considering the protective nature of collateral vessels, this could lead to more serious cardiac events in the presence of an abrupt coronary occlusion.     

Angiographic and clinical characteristics of patients with acetylcholine-induced coronary vasospasm on follow-up coronary angiography following drug-eluting stent implantation

Recent studies have shown that drug-eluting stents (DES) induce vascular endothelial dysfunction in both Cypher and Taxus stents. These studies evaluated coronary vasomotion in the peristent coronary segment for 1 lesion with 1 DES. The angiographic and clinical characteristics of real-world patients with coronary spasm following DES implantation have not been well documented. METHODS AND RESULTS: All patients at our hospital who underwent coronary angiography at follow up after DES deployment (Cypher and Taxus stents) between July 2007 and March 2009 were included. We performed an acetylcholine (ACh) provocation test for diagnosing coronary vasospasm in 3 vessels, except in patients with significant stenosis or contraindications to ACh administration. ACh provocation test was positive in 36/55 of the coronary arteries (65.4%) and in 30/42 of the patients with DES (71.4%). There was no difference in the positive rate between patients with and without symptoms. A total of 13/20 asymptomatic patients (65.0%) also showed positive results. In patients with positive results in the ACh provocation test, vasoconstriction at segments distal to the stent was exaggerated compared with corresponding segments in non-stented vessels (0.46 ± 0.27 versus 0.31 ± 0.20, respectively; p = 0.008). Vessels with positive results had a longer stent length compared with those with negative results (31.6 ± 13.6 mm versus 24.2 ± 11.2 mm, respectively; p = 0.049). CONCLUSION: Coronary vasoconstriction was exaggerated at distal segments in DES-implanted vessels compared to non-stented vessel segments and stent length was longer in the ACh provocation test positive group.