In-Stent Restenosis (Stent Reblocked) in Less Than 30 Days

Current Postings (17):

• 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?
Forum Editor, Angioplasty.Org, February 9, 2007

• 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.
Tom, New York, USA, February 5, 2007

• 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?
Forum Editor, Angioplasty.Org, December 2, 2006

• 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
Donald Hiebert, McPherson, Kansas, USA, November 17, 2006

• 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.
Forum Editor, Angioplasty.Org, July 12, 2006

• 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, New York, USA, July 10, 2006

• 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.
Forum Editor, Angioplasty.Org, July 7, 2006

• 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?
Jim, New York, USA, July 6, 2006

• 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?
Forum Editor, Angioplasty.Org, April 7, 2006

• 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, Lee's Budget Bouncers, Atlanta GA, April 6, 2006

• 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.
Forum Editor, Angioplasty.Org, April 6, 2006

• 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?
Sherry, Lee's Budget Bouncers, Atlanta GA , April 6, 2006

• 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.
Gerald Oros, OrosCo Product Specialties, Collinsville, IL, December 01, 2005

• 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.
Mohan, Goa, India, May 12 2002

• 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
Tim Cadarian, Winnipeg, Manitoba, Canada, April 24 2002

• 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!!
Andrina Hargreaves, PSCC, Riyadh, saudi Arabia, March 26 2002

• 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
Dave, Lynn, Massachusetts, USA, March 21, 2002