Vasodilatory Effect of Subsequent Administration of Fasudil, a Rho-Kinase Inhibitor, Surpasses That of Nitroglycerin at the Concentric Coronary Stenosis in Patients With Stable Angina Pectoris

Background Recent studies have suggested that the Rho/Rho-kinase mediated pathway (Rho-kinase pathway) regulates the vasomotion of arteries in pathological conditions. However, it remains unclear regarding whether this pathway regulates the coronary vasomotion of atherosclerotic lesions. Methods and Results The coronary diameter at the concentric stenotic site, which is considered to reflect the whole circumferential atherosclerosis, in patients with stable angina pectoris (SAP; n=11) and the control site in patients with SAP and chest pain syndrome (CPS; n=9), was measured at baseline and after the intracoronary administration of nitroglycerin (200μg) and the subsequent intravenous infusion of fasudil (30mg for 30 min), a Rho-kinase inhibitor, during coronary angiography. The change in the diameter with fasudil at the concentric stenotic site (22.0±10.0%) was significantly higher than that with nitroglycerin (4.1±6.0%, p<0.001) in patients with SAP. Meanwhile, the vasodilatory effect of nitroglycerin and fasudil at the control site was similar in both group of patients (25.5±17.3% and 21.9±14.9% in SAP and 34.4±20.8% and 33.2±23.6% in CPS, respectively). Conclusions The vasodilatory effect of the subsequent administration of fasudil surpassed that of nitroglycerin at the concentric coronary stenosis in patients with SAP, thus suggesting that the Rho-kinase pathway regulates the coronary vasomotion of atherosclerotic lesions.