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Stenting Closed Bypass Grafts

Post stories and questions about bypass grafts that closed up and were reopened with angioplasty and stents.

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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
Vic, CAD patient (no procedures and hoping), Myrtle Beach South Carolina, USA, March 31, 2008

• 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.
Forum Editor, Angioplasty.Org, May 15, 2007

• 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.
MJV, Hawaii, USA, May 11, 2007

• 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.
Tom T., Phoenix, Arizona, USA, May 7, 2007

• 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.
Forum Editor, Angioplasty.Org, May 5, 2007

• 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?
MJV, Hawaii. USA, May 5, 2007

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