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Stenting Closed Bypass Grafts 
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Current Postings on This Page (6): • Stenting and bypass is not a cure but often a
necessity. However, unless you just want to get back to the same place
as just before the procedure you need a plan (prevention) here is two web
sites that can help immensely. http://heartscanblog.blogspot.com/
www.trackyourplaque.com • Try to do two quick answers. Tom -- sometimes
it's not technically possible to open the original native vessels, because
of a chronic total occlusion or other anatomical issues -- in your case
it WAS possible. MJV -- vein grafts are more susceptible to closing up
than the Internal Mammary Artery (IMA) -- but 16 years is a long time for
those grafts to be open ("patent") -- why they (or any artery)
closes up is still not really known -- when it is we'll be a long way toward
conquering coronary artery disease. In any case, it would be a good sign
that they lasted so long. And yes, it is possible to have more angioplasties
or even a second bypass -- although each case is individual. • Thanks very much for this clarification. An angiogram
last year showed the graft to be "wide open". In one year it filled in
95% and 70% in two spots. Is that unusual--particularly since it had supposedly
been open for 16 years and my cholesterol numbers were good (with vytorin).
What can I expect next? Does this mean that given the same conditions it
will fill again quickly ? If it does what happens then? Can it be fixed
with angioplasty? Or am I likely looking at bypass again? Thanks . My cardiologist
is considered to be very good technically--but he is not so good at answering
such questions. • I am curious. Why would stents be used to unblock
vein grafts? Why wouldn't the cardiologist stent the original artery blockages
instead? (Today cardiologists seem willing to stent almost any blocked
artery.) Wouldn't the reopening of an artery be better then reopening a
vein graft? I had a LIMA artery graft and a vein graft close after only
4 years, and the cardiologist and heart surgeon rejected the idea of trying
to open them. Instead they stented the original blockages. • MJV -- there has not been much difference shown
between the CYPHER and TAXUS stents. And it's not that it's "unsafe" to
use these stents in reopening a closed vein graft -- it's that it is technically "off-label".
That means the FDA has not specifically approved the device for this use,
but also it hasn't restricted physicians from using it this way because
no data has shown it to be dangerous. Drug-eluting stents have less restenosis,
less reclosure -- something that would be important to avoid in a vein
graft. The downside of drug-eluting stents is the need to take dual antiplatelet
therapy (Plavix or Ticlid plus aspirin) for a year or more. • I just had 4 DES put in in 16 year old grafts--3
in one place. The occlusion was 95% at the distal end of a vein graft and
70% in another place. I was on the table three and a half hours and it
was clear that the cardiologist was having trouble getting at the spot
and properly implanting the stents. In 2003, it was considered unsafe to
stent vein grafts and complex blockages with the Cypher coated stent. The
stents used in me were Boston Scientific Taxus Express. Do these stents
and improved techniques over the last few years make safe the use of these
stents in such situations? |
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