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Reply to Letter to the Editor
We thank Dr. Kounis and his colleagues for their comments regarding the link between coronary vasospasm, allergic reactions, and the use of drug-eluting stents. As their discussion points out, a hypersensitivity response to an allergen, such as a material included in a stent, may cause unstable angina or myocardial infarction. Our discussion of patients with severe coronary vasospasm after stent placement includes several potential causes, including abnormal vasomotion due to the drug or polymer.1 Other hypersensitivity reactions have been reported as well after drug-eluting stent placement.2 In addition, abnormal coronary vasomotion has been reported 6 months after drug-eluting stent placement.3,4 We agree that in patients with a history of atopy, multiple drug allergies, or a history of coronary vasospasm, additional care should be taken in the preparation of the patient and the choice of stents used.
Brigitta C. Brott, MD, FACC
William B. Hillegass, MD, MPH, FACC
Division of Cardiovascular Disease
The University of Alabama at Birmingham
Birmingham, AL 35294
E-mail: bbrott@uab.edu
References
- Brott BC, Anayiotos AS, Chapman GD, et al. Severe, diffuse coronary artery spasm after drug-eluting stent placement. J Invasive Cardiol 2006;18:584–592.
- Nebeker JR, Virmani R, Bennett CL, et al. Hypersensitivity cases associated with drug-eluting coronary stents: A review of available cases from the Research on Adverse Drug Events and Reports (RADAR) project. J Am Coll Cardiol 2006;47:175–181.
- Hofma SH, van der Giessen WJ, van Dalen BM, et al. Indication of long-term endothelial dysfunction after sirolimus-eluting stent implantation. Eur Heart J 2006;27:166–170.
- Togni M, Windecker S, Cocchia R, et al. Sirolimus-eluting stents associated with paradoxic coronary vasoconstriction. J Am Coll Cardiol 2005;46:231–236.
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