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In-Stent Restenosis (Stent Reblocked) in Less Than 30 Days
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Current Postings on This Page (21): • For people having this much restenosis Plavix may be part of the problem.
I am Plavix resistant Since being switched to Effient no more major trouble. • Metal allergy to stents. Just because they are
males doesn't make them exempt. My theory is still the same, metal allergy.
If you restenose quickly you are probably more allergic than not. Blood
allergy test. blood allergy test blood allergy test. Nickel and molybdenum
allergy is manufacture reason for restenosis. My wife is confirmed metal
allergic to 3 metals in her 316L stainless steel stents. • Troy -- if you are restenosing (reclosing of stent)
have your doctors discussed with you a drug-eluting stent -- they were
specifically designed to lower the rate of reblocking. • Have had 2nd stent non drug all metal to Circumflex.
Seems every 4 weeks my stent closes up. They reopen in cath lab but it
looks like I'm doomed to either more stents inside of stents or :? What
is my option to heart? Should I get a
bypass? • Tom -- when you say between each stent, do you
mean inside the stents? Or literally between the stents (usually for
long lesions, stents are overlapped. Also, we have not heard of a procedure
where coronary stents are removed physically. Arterial reconstruction
in
areas where there had been 9 stents doesn't sound possible. Also, if
you are having the native arteries bypassed, why would the stents need
to be
removed? Can you clarify? • I'm a 43 year old male with a history of 9 stents
in 7 mo., 4 surgeries. On the 8th month went in having unstable angina
and elevated cardiac levels, was taken for another cath., where they found
that I had blockages between each stent in the LAD at 80% and would have
to have a CABG Triple with artery reconstruction to REMOVE the stents. • Don -- haven't had many patients with a dozen
stents write in. As you know that is a lot. When your physicians looked
at CABG (bypass surgery) they concluded it wasn't an option. Why was that?
We ask that knowing that the answer might be that there are too many stents,
what's known as a "full metal jacket", and no place left to do
the bypass. Did your cardiologist have any answer as to why you've blocked
up so quickly, even with drug-eluting stents which specifically were designed
not to reblock. A final question, one prompted by another such case in
our Forum. Were you in the military and were you ever given the anthrax
vaccine? • I am a 55 year old male with multiple health problems.
At this moment I have had (12) twelve stents placed in the last (12) twelve
months. 11/30/05 (1) taxus express2 -- 12/02/05 (2) tax exp2 lad -- 3/01/06
cordis(1) -- circa 03/07/06 (5) five tax exp2 lad -- 06/05/06 (3) three
cordis distal lad/mid lad/prox lad. 09/04/06 chest pain had (3) arteries
blocked all blockage was in stents 10/31/06 chest pains (3) more blocked
arteries. Looked at option of multiple CABG , not possible cleaned out
all stented areas looked at options . All of the blockage was related to
scar tissue. Ran blood studies to rule out Apheresis procedure. Help • Jim -- thanks for the update. Whether or not the
Cypher drug-eluting stent is better than the Taxus for diabetic patients
is a matter of great debate in the "Stent
Wars". Depending on which study or clinical trial you look at,
or who you talk to, you could go either way. One thing is sure: both stents
work well in diabetics, something that bare metal stents or "plain
old balloon angioplasty" did not. However, something over which there
is absolutely no debate is that smoking is a big risk factor for coronary
artery disease, as well as restenosis. It is a very tough problem on a
personal level to deal with and many studies have urged hospitals and doctors
to be more aggressive in helping their heart patients kick the habit. So,
congratulations to your wife for doing so! Reducing risk factors is a critical
step towards heart health. • Supposedly the Cypher Stents are even better than
taxus for diabetic patients (or that is what we were told) and it seems
to be working because she only had 1 small blockage this time around (70%
at one site vs the entire artery being plaqued up). She stopped smoking
6 months ago, takes her meds like clockwork (except for Plavix which the
Dr stopped 2 months ago - 3 months after last 5 stents went in to reopen
the entire artery). This time he used a cutting balloon and no stent was
placed and he still said no Plavix. No ultrasound device has been used
to date. • Jim -- that is a large number of stents (kind
of a "full metal jacket") in one artery. And they all of the
drug-eluting variety, which have been shown to be quite effective in reducing
the incidence of restenosis in diabetic patients. We assume that you been
doing everything you can to reduce risk factors (no smoking, lifestyle
modification, compliance with medications like statins, etc.) and have
been on the required antiplatelet therapy of aspirin and clopidogrel (or
ticlopidine) necessary to prevent thrombosis in drug-eluting stents. Has
the doctor inspected the stent site with intravascular ultrasound? This
imaging technology (read about it in our new "Imaging
and Diagnosis" section) can very precisely show how the stents
are placed in relation to the vessel wall, whether they are fully expanded,
etc. • Last year, after complaining for 6+ mos of chest
pressure, my wife, who is diabetic for 35 yrs (well controlled), had an
irregular EKG but passed her stress test finally convinced the dr to do
an angiogram because he told her it was gastric and the stomach dr said
it was not. She started out with 3 Taxus stents (much to the drs surprise)
for a 95% blockage in her RCA. The pressure was better but still there
and 2 more Taxus stents were placed 3 months later for a 50% blockage in
the RCA. She felt 100% better. No chest pressure at all. 4 weeks later
after telling the dr she felt awful and him saying there is no way she
could have closed the artery, she had an acute thrombosis and the last
2 Taxus stents closed abruptly but were reopened with 2 more Cypher Stents.
She felt okay for about 1 month and the pressure began again. The dr said
there was no way her artery had another blockage because all stents were
patent 30 days ago. She got worse as time went on and at 3.5 months, started
getting a burning in her upper abdomen, had jaw pain and was winded. 1
mos later, an angiogram revealed the entire RCA was occluded. 5 more Cypher
stents reopened the artery - yes, making this a total of 12 stents - and
she felt great! At the 1 mos mark, the pressure came back and at the exact
4 month mark, an angiogram revealed a 70% blockage again. The good news
is this time the entire artery was not occluded - just 1 section. The dr
used a cutting balloon and removed the plaque instead of adding more metal
but it is now 1 mos later and her chest pressure is coming back, her BP
elevated at times and intermittent jaw pain and she is winded with swollen
ankles. Is this common or has anyone else had similar events (restenosis
in such a short period). She dreads going to the dr next week because he
is going to say again there is no way in 1 month, etc etc. To date, every
time she has said she had the pressure, she has had a blockage so I'm not
sure why he says the same thing each time but she can't even believe this
is happening. We have been told it is a small vessel yet the dr said that
with 3 sets of stents inside one another, he had plenty of room to move
around the "cutting balloon" so it can't be that small. Any comments? Any
advice? Anyone else had this problem? • Sherry -- this topic is about stents closing up
in a very short time of 30 days or so. Your husband's seem to have stayed
open for a couple of years, and then have closed up. Just curious. How
was it determined that both stents have closed? Was an angiogram done in
the cath lab? Do you know what kind of stents were used originally? Drug-eluting
stents? (Your husband should have been given a card with that information
after the procedures.) Let us know what happens -- has there been any discussion
of re-opening the blocked stents with a balloon? another stent? If not,
why not? • He had one put in Feb 2004 and in Dec 2004 he
had the other one put in. Last week March 30th 2006 went we back to the
doctor because he has been having chest pains and they found that both
stents in that one major artery has closed! • Sherry -- we're curious, how long ago were the
stents placed? And what type were they (if you know) -- bare metal stents
or drug-eluting (medicated) stents? While your husband's doctor is right
-- stents can't be removed -- but they can be re-opened, sometime with
a balloon, sometime with a special radiation-emitting catheter (called
brachytherapy), but also with another stent -- a stent inside of a stent
-- the newer drug-eluting stents have restenosis (reblocking) rates in
the low single digits when used as the initial stent. While these coated
stents are not currently approved for treating a reblocked stent (called
in-stent restenosis) several studies presented at last month's American
College of Cardiology meeting showed very excellent results. It is hoped
that the FDA will expand the indications in the not too distant future,
but you should discuss the options with an interventional cardiologist.
Let us know what you find out. • Please help, my husband had two stents put
into an artery and now both have closed. I'm not sure what that means,
but the doctor stated they can't remove them and they must stay forever!
Im crying all the time because he is so young only 45 and loves to do
things and can't ...explain to me what will happen and will he get better? • Dave: Consider the possibility that your
endothelium is dysfunctional due to inflamation and constriction of your
vascular system. This may be caused by a variety of cardiac risk factors.
Ask your doctor to evaluate you for endothelial dysfunction. • I had PTCA done for 90% stenosis to right
artery in Aug. 2000. Till day there is no problem. I had stress done
in Oct. 2001 which was normal. I do walking at the rate of 5 kms per
hour. There is no pain .the procedure was done at Wokhart Hospital Bangalore. • I had a angioplasty with a stent with a
severe 99% stenosis in the distal right artery. Should I be pain free
or have a little pain ever so often? The left ventricular with ejection
fraction was estimated at 60% and the left ventricular pressure was 140/23mmHg.Could
you please explain what that means? thank you • Hi Dave No easy answer i am afraid, sometimes
just luck. Stents have about a 25- 30% chance of re-blocking, so you
are not alone. There are some factors which make this process more likely
such as high cholesterol, blood pressure, obesity, smoking and small
sized arteries. It does happen and there is no real way of knowing who
it will happen to. You should wait and see what your next angiogram shows
and discuss your risk factors with your cardiologist. Beyond that there
is not much you can do, its really a waiting game, one you have passed
the +/- 6 month mark, you have a pretty good chance of a long life out
of your stent! I hope this helps!! • I'm 43 -- had angioplasty with stent due to 60%
blockage on February 28, 2002. On March 15 was informed it is clogging
back up (abnormal EKG) angina with chest pain after 5 mins. on treadmill
and will receive another angiogram and possibly another stent. What causes
restenosis in such a short time frame (less than 30 days)? Thank You, Dave |
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