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In-Stent Restenosis 
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Current Postings on This Page (69): • Wow I just wish all of us in the stent club the best. Had my first MI at 36 one stent placed restenosed 8 months later 2 more stents. Made it ten years then while skiing another MI another stent. Made it 5 years and had another large stent placed in Guadalajara a year later to the day 95 percent blocked another stent 4 weeks ago. wondering if I'm feeling a little something today. I'm on my way back to Mexico fingers crossed I'll be near the help when I need it
• I have had a quadruple bypass. Each year after that I had a stent put in. I now have five stents and a stent within a stent. It has been two years now and I get heavy pressure when working for a long duration, not necessarily hard physical work. I have been given Ranexa to add to my long list of drugs. I have to decide whether to use this or have an angiogram. I believe I am blocked once again. What should I do??? Try to fix it or just relieve it. • my son has a stent that they inserted in
feb. 09, he has cad, chf, hypertension and cardiomyopathy...in aug.
2010 he had
a blood clot form and they went in to unblock stent (had heart attack
) a dr. had taken him off his plavix in jan 2010. which is why he suffered
another heart attack, he hasn't been feeling well....but due to no ins.
has
not been to see a cardiologist since aug. 2010. does anyone know of any
programs to get medical care at low or no cost? He needs help fast !
Please respond?!!!!
thanks! • Elizabeth in the UK
-- The question is whether what looks like a 50% restenosis on the angiogram
is actually causing ischemia
(lack of blood flow and oxygen). An FFR
measurement performed during the angiogram
is one way to determine this, but a nuclear stress test might also show this.
As for predicting whether this will progress, that's hard to say. Much depends
on the location of the stent and your clinical profile. We assume youre controlling
the risk factors that are under your control (diet, exercise, stopping smoking,
if you did, etc.) • All so interesting. I am resident in UK. In 2006 had stent drug eluting
Taxus 20 mm x 3 mm inserted in proximal LAD. Was initially told it may not be
stentable and I'd need a by pass but stent inserted ' Managed to get it in '
the Cardiologist said. It never really felt right. In August 2006 had to be restented
- stent within a stent - 33 mm x 3 mm Cypher. Now April 2011 angina returned
. Angiogram showed 50% restenosis. Waiting for the nuclear medicine scan. Question
I cannot get answered is - will 50% become 60%, *0% , 90%? The first time I had
the stenosis they said it was very badly stenosed and that it had been happening
for a ' long
time '. Is this inevitable? • In 2008 I had a angioplasty and they said
i was 50 percent blocked and in 2009 I started having breathing problems
and tired and just didn't feel good some times I couldn't even talk
and i would get out of breath they did a stress test two other test by
taking
picture of my heart and so forth they said these test were 90 percent
sure everything was same in the blockage as it was in 2008. i insisted
they do another angioplasty and they said it would show I'm still at
50 percent I said that will be great but I still want the test . It
was 70 -80 and 90 percent blocked they put two medicated stents in and
ballooned
two places. so don't believe the test all the time if you don't feel
good . They couldn't believe I had that blockage. Four months later
I had chest pain when i would walk and hardly any exertion and this went
on from march 4th to the 11th I finally tried a nicrto(spelling) pill
and my pain went away so I called in they said come in it sound like
you stents are closing sure enough when they pulled the balloon out
from
the first stents part of the balloon got caught on the stent in the
main artery and cause a 90 percent blockage. I felt good and now I'm
out of
breath again • had drug eluting stent in jun 2008, 99.9%
blockage. felt good about 6 mos., then starting feeling tired and had
angina in my throat. just like b4 stent.
i never had chest pains, only throat pain. complained 2 cardiologist and he
ordered stress test, did not have due to ins not approving, so i just
went on with my
life and angina. continued to have angina and shortness of breath. had another
heart cath by different dr. in feb 2010. dr said 100% blockage and nothing
could be done, i had feeders growing over to right artery to supply me
with blood flow
and oxygen so he put me on isosorbide dinitrate and sent me home. still having
trouble and having cramps on left side of chest i had another heart cath in
aug 2010 by yet another dr. he confirmed 100% blockage of the stent and
ordered more
meds for me. then i went to my VA cardiologist and he changed some of my meds
yet again and recommended me having the surgery that fixes the blocked stent.
its not open heart surgery. its where they go in your neck and approach the
heart from the top down. has anyone had this surgery? i am 49 years old
and do work
every day in a fairly active job. feel pretty good. help anyone? take lots
of meds. • I have just had to be restented after having
had a drug-eluting stent inserted in August. Thank you for the
post below re: the patients emotions following a restent. I know I am not alone and
I appreciate having this site to read and relate too. I know others have
gone
before me in this journey and survived. Best wishes to you all. • Bob from Irvine
-- apposition is literally "positioning close to each other". So a stent
that is well-apposed is short-hand
for a stent that is positioned right against the vessel wall. A malapposed
stent has a gap between it and the vessel wall, which is though to be
a condition that encourage stent thrombosis. A stent can be malapposed
if
not fully expanded
-- something which Intravascular Ultrasound is excellent at revealing.
"Late malapposition" has recently been shown to occur when the vessel
wall moves
away from the stent over time, possibly due to a hypersensitivity reaction
between the vessel wall and the polymer on the drug-eluting stent. • I'm reading the article Advances
in Stenting with the Brazilian doctor,
Fausto Feres. He talks about apposition and malapposition in stents. What is
apposition? • I had 3 stents in my RCA 16 years ago at
age 36 after a heart attack. I had another heart attack 6 years ago
and the cause
was blockage within the stents. Recently I found my doctor wasn't being
very aggressive when I wasn't feeling well. So while in Guadalajara
I told my
story to a cardiologist and was in the cath lab the next day. Good thing
95% blockage in the same area they were able to put a long medicated
stent within the stents and i think they did a good
job $7500. • PhilR -- Celebrex is a COX-2 inhibitor,
and there have been studies linking some of these drugs to heart problems,
specifically
the formation of blood clots in the arteries: Vioxx is the most well-known
example and it was removed from the market. Celebrex has been studied
and the results, while some were inconclusive, were enough to cause concern
for heart patients, as reported
in
this 2008
New York Times article. • I have had a stent for the last 16 years and
had no problems, two months ago I went onto Celebrex for a knee problem
and this past week had to have the stent opened and a further stent inserted,
coincidence, I am not sure but would
enjoy comments. • Melanie, Red and all readers -- Dr. Paul Teirstein of Scripps Clinic wrote an excellent editorial, "Drug-Eluting Stent Restenosis. An Uncommon Yet Pervasive Problem", published online June 21, 2010 in Circulation, discussing not only the technical side of this issue, but the need for cardiologists to reassure patients that re-treatment usually results in good outcomes. He notes the tremendous progress made in interventional cardiology from the time when balloon-only angioplasty experienced up to a 40% restenosis rate to the current drug-eluting stent (DES) technology where restenosis rates are in the single digits. Yet he states that almost every day, his clinic sees a patient whose stent has restenosed. He writes that:
Regarding patients, he urges physicians:
There are multiple reasons for stents to reclog -- and
again this is not common, but Dr. Teirstein's suggestion that patients
discuss these issues with their interventional cardiologist is of prime
importance. Hope this helps and look forward to your comments. • My husband has had MI a year ago and had
3 stents placed in his heart. Since then he has exercised, taken his
medications, and watched what he eats but his stent is 80% clogged.
Can you tell me what has caused this? • I'm not sure I should be reading all of these stories. I am getting more
depressed. I had a 70% blockage of LAD in Dec 09. Had a taxus drug eluting stent
put in. Felt great for about 9.5 mo. Two weeks ago symptoms reoccurred: shortness
of breath and chest tightness. I had a different kind of drug eluting stent inserted
in the "old" one. It's slightly larger. I'm trying to find out the odds of
having scar tissue (what I was told happened) re-block this one. It is so worrisome
and I'm trying hard not to think about dying constantly. I'm 61, female, too
heavy but not morbidly obese, and too sedentary. I'm making lifestyle changes.
Any advice appreciated. I'd really like to know the stats on re-blocking a
second
time. • Have 4 stents in heart.last month started
taking a water pill for blood pressure, started having chest pain,
tightness, ache in left arm, jaw ache, shortness of breath. Went to ER
3 times in
3 weeks, ran all the normal test, blood work, ekg, stress test. All
came back normal. What problem am i having? i fell doomed , no doctor
is listening
to me, just send me home. • 2 years ago, I had 2 stents put in my left
leg and 1 in my right leg. All 3 are clogged enough for replacments.What
happens to the clogged stents when
the new stent are put in. i did no exercise because of bad back and because
I'm diabetic i couldn't have the steroids. This time hydrocodone ~ walk
an hour or
so. I am petrified of the procedure.Also 2 heart attacks and 4x bypass. • I am a 49 yr old woman who had 2 bare metal
stents inserted into my Circumflex on July 5 2010. Back to the hospital
Aug 25 2010 (7 weeks later) to have another catheterization (this time
in my right arm) they found I had restenosis and this time used drug
eluding [eluting] stents by Xience V. In addition, my RCA which was
clogged 20% in July was now clogged 90% so a third stent was inserted.
I now
have been itching the entire time since I left the hospital and no
drug changes so I believe it has to be the Drug Eluded [Eluting] Stents.
I
will be calling the Doctor tomorrow. I also have been diagnosed with
CHF so my breathing is still an issue and I am still tired all the
time. Has anyone else had an itching problem with the Xience
V Stents? • Charlie C in London --
thanks for your post. Your concerns/fears are not unique. If you read
over our Forum Topic, "Not
Feeling Well After Stenting", you'll find a
number of posts where patients are having pains post-stenting. But pain
is such a subjective measure that
we always recommend discussing these issues with your cardiologist. There
are tests that can be done, should the cardiologist feel they're warranted
-- a stress test would hopefully show if your pain is in fact related to
any ischemia caused by a narrowing. And there are treatments for DES restenosis,
but that is jumping ahead. We are also putting your post on the Forum Topic,
"Exercise,
Sports and Physicial Activity After Angioplasty"
-- you may get some good feedback from other there. • I had 2 drug eluting stents placed last year:
in LAD (Oct 2009) and RCA (Jan 2010). In the last month, I noticed chest
pains again but only when I start exercising (cycling) and only at the
start of the ride before I am warmed up. After about half an hour, the
pain will go away and then no matter how hard or how long I cycle, there
will be no chest pain. Is this likely to be restenosis and if so is it
just really early stage restenosis because after warming up, presumably
the arteries are more relaxed and expanded so the narrowed artery is
widened from relaxing them. During the pain, I have no breathing difficulty,
just
the angina pain. After it is gone, I have continued to ride for over
100 miles and had my heart rate up to 160. Seems like restenosis but can
restenosis
feelings change like this? If it is just early stage small amount of
restenosis, could it stop or will it keep getting narrower unless it is
treated? At
the moment if I didn't push my heart by exercising hard I would not have
noticed the change going about everyday life. Can someone put my mind
at ease? • I am a 43 year old woman, I had stent placed in
my RCA in June of 2009, it is now August,2010 and I am going in for a
catheterization because my nuclear
stress test indicates that my RCA has blocked again it has only been one year
and both of my parents passed away in their 50's from the same thing, my problem
has been getting the doctors to believe my symptoms the only symptoms I experienced
was nausea, I am a Emergency Medical Technician and I know women present different,
The only thing I can tell other women is you know your body and if something
doesn't feel right it probably isn't. Pay attention and be persistent
that is the one
thing that will save your life. • Bare metal stent in RCA in Nov. 2005. Jan. had
stress test which was abnormal but told not to worry. Followup visit in
May, still complaining of fatigue, numbness in arms and Shortness of Breath.
Complaints brushed aside. Sept. had another stress test/abnormal, led to
in clinic heart cath, followed by hospital heat cath only to discover the
stent could not be accessed due to weird placement. Told collaterals were
forming. Never felt right after MI & stent, but followed orders. June 08,
another battery of tests due to worsening symptoms and fear of another
MI. 2 months later saw different cardio doc for results, didn't know what
I was talking about. He gave me new meds and said follow up with reg doc
(his colleague) in 4 months. Fed up, I suffered up to June 2010 and after
3 nights of waking with severe chest pain, not relieved with 3 nitro's,
went to ER with similar symptoms of prior MI. Heart cath next day. Another
doc from the same practice performed procedure. In recovery, while still
under, he told spouse no MI, just Unstable Angina. Sent home with script
for lopressor 25mg. Viewed
cath procedure & records. Stent 100% closed. New vessel on LCA now 50% blocked.
New MI in RCA=DIE • Kalyani -- 13 years post-stenting with no symptoms
is pretty good. You have posted in the Topic about "in-stent restenosis",
but there's nothing in what you've written to indicate that this is a reblockage
of the stent(s). Since your husband is a diabetic, he's at higher risk
for coronary artery disease in general. It's possible that this is a new
narrowing. The only way to be sure is by testing -- either a nuclear stress
test or,
as
some cardiologists are now recommending, a CT Angiogram would show more
information about blockages -- but ultimately a cardiac catheterization
(invasive angiogram) would show the most information, and also afford a
possibility to open up a stent that may have restenosed, or stent a new
area. But, of course, one should start with the least invasive and simplest
tests first. Your cardiologist is the best source of figuring out the answers
to your question, determining if in fact your husband's symptoms are related
to a narrowing, and then where that narrowing is and how to treat it. • My husband had angioplasty with two stents in
1997. he has developed symptoms again. He is 60 years old diabetic. He
has a high position in his job and hence is generally subjected to day
to day
stress.
I wish to know the best course of action.Thanks. • Puzzled -- so are we. Not sure what a "disintegrated stent"
is -- possibly part of the stent fractured, but did your husband have symptoms?
As for taking out a stent, that's not possible -- but what is done is that
another stent is inserted inside the blocked stent and expanded. • My husband has had one of his main arteries stented
for about 5 or 6 years. About 4 months ago the stent disintegrated and
they did another procedure to insert another stent. Since that time the
stent reblocked and they had to do another procedure to take that one
out and inflate the balloon and insert a shorter, wider stent. Last week
he
had a stress test that showed that the blood flow in restricted again.
This will be three stent replacements in 4 months. He has been on Plavix
since the first one was replaced. He had a lot of problems at first with
very bad stomach problems and feeling really bad. His cardiologist is
on vacation next week and he needs the procedure again. They are considering
a change in the procedure that is something new. I don't know what is
different,
but my husband has to be under a lot of stress trying to work long hours
and wonder
what
could happen if he doesn't get this done soon. • Wendylng -- End, or edge,
restenosis can be caused by a number of things -- sometimes the stent
placed is not long enough
to cover the diseased area, something that is difficult to see using angiography
alone. More and more interventional cardiologists are using IVUS
(intravascular ultrasound) or other intravascular imaging tools to see these areas more
clearly. • Hello out there... am a 50 year old woman that
had an MI last March of 2009...This week after a CT scan with contrast
its evident that there is stent end restenosis of 70% and my cardiac
interventionalist from NY is going to stent next week...I am curious to
know if this is result
of Plavix insufficiency or just the particular type of stent...Endeavor?
He claims there is very little
chance with the newer one he will implant.... • I am 49 and just had a heart attack; doctors say
no heart muscle damage. They found blockage and placed medicated stent.
I am on Plavix, Aspirin, Lopressor,
and Zocor now. I am scared to death and sick to my stomach after reading these
posts. I wish now they did not put stent in and just did angioplasty or nothing.
I have gone on strict heart healthy diet (veggies, fruits, whole grains, fish,
non fat dairy, nuts/seeds) and hope that will save me. Does anyone have good
news about these stents. I feel the doctors don't give you your options, they
just seem to put in the stents!! • There are a few heart treatment centers in the
US that offer coronary brachytherapy with the Novoste Beta-Cath 3.5F
System for patients prone to in-stent
restenosis. • Concerned Wife -- it is great to see that you,
your husband and cardiologist have discussed your case in such detail
and with knowledge. As you wrote in your original post, you certainly
have done your research! This was, as you've stated, atypical plaque.
Hopefully, now
that
the regrowth of tissue has been pushed back, a more typical healing
of
the endothelium can occur, covering the stent struts (but not too
much!) and stabilizing the inner lining of the artery. The fact that the
arterial
wall now looks smooth (we assume this was confirmed via IVUS) is
good. Your
case
definitely
points
up why intravascular imaging technologies like IVUS are so important.
And
again it's great that your husband's cardiologist not only uses IVUS,
but also that you and he/she communicated clearly. This is so important
because
non-communication only amplifies the very scary unknown -- and the
last thing CAD patients need is that kind of stress! Thank you for your
posts. • He did have IVUS, and the Dr. said it was tissue-and
that the stent was fully opened-I think that's why he was surprised that
the middle of the stent, and not the edges was where the occlusion was-originally
the occlusion had a 'crackled appearance', it didn't look like the typical
cholesterol/fat build up-my husband had been under a HUGE amount of stress-
and now the arterial wall
are smooth (he's on plavix and lipitor). • Concerned Wife -- We'd agree with your doctor
that 6 weeks is early for restenosis. Recent 5-year pooled data from the
Endeavor
stent
program show that most restenosis occurred between 6 months (< 2%) and
12 months (5.4%)
and
then only increased to 7% over 5-years (with virtually no late stent thrombosis).
It's
hard
to believe
that
the
drug wasn't
evenly
distributed,
since it's embedded in the polymer. The story of what occurred might have
been made clearer using IVUS
imaging within the artery itself, to see what
the plaque was made of, whether or not the stent was fully expanded and
was in apposition with the artery wall. If this were to happen again, we
would suggest discussing IVUS with the cardiologist (they too would be
interested
to understand this phenomenon). A technique that has been used, although
it is technically "off-label", is to place a different stent
inside the restenosed stent -- it is thought that if the zotarolimus drug
in the Endeavor
didn't work, perhaps a different drug might. • My husband had 3 Endeavor stents placed in LAD,
then on plavix and Aspirin, 6 weeks later symptoms came back, started
on beta blockers, no relief, he had another angio and one stent was 90%
occluded in the MIDDLE of the stent...had angioplasty on the stent. Our
dr. said
this was unusual (both because it was so early after the stenting AND
because it wasn't on the distal edges)...he wondered if maybe the drug
wasn't evenly
distributed...so now what? Do we wait for another episode, I've done
an exhaustive search and can't find much literature about this scenario
What
% of stents restenose for the 2nd time and if so, do they keep doing
an angioplasty on the blockage? We are going for a f/u appt to ask these
questions,
but I'm thinking maybe we should have a second opinion..to be prepared
ahead
of time, just in case. • Elizabeth -- First about the Metoprolol recall:
there have been a few of these in the past year, involving generic manufacturers
Ipca and Ethex, although there may be others. The recalls were mostly about
tablet size being thicker than specified. Contact
your pharmacy to make sure your Metoprolol is not a recalled manufacturer
or lot number -- if it is, your pharmacist will exchange it for a non-recalled
Metoprolol. Secondly, and more important, is your report of very low blood
pressure, tiredness, etc. Metoprolol is a beta-blocker -- it is a drug
for people with high blood pressure -- it lowers blood pressure. If your
blood pressure is "very low", you should see your doctor ASAP
to get your meds adjusted.
But don't worry all the time about the stent re-blocking. If it was a drug-eluting
stent, the incidence of restenosis (reblocking) is only 5-10%. • I am on Metoprolol and now heard it has been
recalled. My blood pressure and pulse are very low. Is this a safe med?
I had a stent put in and bypass in Nov. 09. I am so tired that I could
sleep 10 hours a day. I am also on Zocor and my cholesterol is like 125.
I don't
feel any better and they say I should since both arteries were 95% blocked.
I am 65 and worry all the time about the stent reblocking. Started to
have palpitations. I am glad to be alive but is this the kind of life I
have
to look forward too? I walk everyday and want to
feel better. Help! • Worrying whether or not a stent has "re-blocked"
is obviously something that is stressful for the patient -- it reflects
a concern that the "fix" isn't durable and, as we see, this sometimes
happens. In percentage, with drug-eluting stents, it's less than 10%.
The cause of this re-blocking (a.k.a. restenosis) is multifactorial,
but measuring whether it has occurred is an imperfect science. The return
of angina or other symptoms (shortness of breath, etc.) is one of the main
markers. A return of symptoms would probably trigger one of the standard
tests. A nuclear stress test, such as one using Cardiolite (technetium),
can show if there's a perfusion
deficit
(lack
of
blood
flow
to the heart
muscle)
but it's not 100% accurate -- and it carries a not insignificant radiation
exposure, around 15 millisieverts -- which is why an annual nuclear test
is not recommended. A CT Angiogram can be done with less radiation, but
this
imaging
technology
also is not completely reliable when measuring something like a blocked
stent. The only sure fire test is unfortunately an invasive one: the cardiac
catheterization -- and it's something you might want to do when symptoms
indicate there may be a problem. Especially because if the stent IS blocked,
it can be ballooned open again and possibly re-stented (a stent within
a stent) although tecnically this is "off-label". There have been trials
of a new device, a drug-coated balloon, that have shown good results
in re-opening a blocked stent. These are generalizations, of course, and
a cardiologist may decide to perform
certain
tests in individual
patients
that may not
be strictly "recommended". • Still waiting to hear what tests to take to see
if a stent is blocked. I had a medicated stent put in in Nov. 09. I still
feel tired and am not myself.
I am 65. Also had one bypass by Robotic surgery with mammary artery. How long
does this last? Thanks, Elizabeth • I have a history of heart disease in the family,
and have had hypertension for years. I am 50 yrs of age, I have three
stents in my arteries, two in the LAD which have completely reblocked,
and one
in the RCA which apparently is critical to my survival. I've had to be
aggressive with my cardiologist to get a Nuclear Stress Test, which they
call cardio-lite, every year. Apparently, my heart has grown collateral
arteries to get around the blockage in the LAD. Should I be pushing for
a CT slice angiogram, or even an invasive procedure? My understanding
is that if that RCA blocks up like the other stents did, I won't survive
the
heart
attack. • My father 74 years old had PTCA with stent in
1999 for LAD. Now he has been diagnosed with Stent restenosis 95% blockage.
Doctor has advised using Drug-Eluting Stent within the blocked stent. Please
advise what to do ?
Shall we go for repeat PTCA with stent ? Thanks. • my mother in law had a heart attack 5 years ago
and had a stent. She has restenosis of the same artery. Dr. tried to
re-stent the same artery without
success. He says he wants to treat her with just medications. Shouldn't bypass
be the next option? Is there a possibility bypass would be too risky? Dr.
said her other surrounding arteries are fine. • I recently went through restenting after seven
years without any problems. Scar tissue grew back in one year and was
98% blocked. • both drug coated stents are blocked. Causing stable
angina. what options are there to clear the occlusions. Please advise. • My husband had a bare stent placed when he was
39. About every two years thereafter he required a stent. The older bare
stents did well whereas the drug coated stents had required a stent in
a stent. He is now 56 with 12 stents. How many stents can he take. The
blockages occur at different areas. Now he has developed abdominal aneurysm
that is being watched. What could have caused that? Taking plavix and
aspirin for quite a long time but will switch to newer drug . Just wondering
where
this is going to go and what if new technology is available to help him?
We have a good team of Drs but I can't help wondering what comes next. • I recently (two weeks) ago had two stents placed
in the heart. One stent was placed inside the existing stent. I have had
various degrees of discomfort, relieved by nitro pills. My question is
there a simple diagnostic test to indicate whether there is a major problem
existing? • Ken -- Total occlusions are somewhat complex to
do, but there are specialists in interventional cardiology who do them.
Blocked
stents can also be treated with another stent (see today's
news article about
this). Your cardiologist may be correct. It may be that in your situation,
the stents are not easily re-openable. If you are not satisfied with
that diagnosis,
you
certainly
have the
right to a second opinion. But what your outlook will be is something
that depends
a
lot
on your
health, clinical status, existence of collateral circulation and exactly
where these blocked arteries are. • I had four stents fitted two years ago. Yesterday
i had an angiogram done. My last four stents had all blocked completely.
My cardio said it was not possible
to fix by angioplasty, but medication was all we could do. What can i expect
my life will be like from now on. Please help. • OF in Switzerland -- Plavix doesn't keep restenosis
from happening. It's an antiplatelet drug --it keeps blood from clotting,
so it is used to reduce the incidence of stent thrombosis (clotting), a
sudden and very serious event. But it's not an "antidote" to the DES. Restenosis,
unwanted
growth of tissue, can be caused by a number of things: it's the progression
of disease,
it can
depend
on
the
location
and length
of
the
blockage, etc. Where did you get the idea that your new 75% blockage occured
because of endothelial damage caused by placement of the first stent? Especially
since the blockage became evident 7 years later? Sorry, but your conspiracy
theory flies
in the face of many hundreds of highly-public transparent clinical trials
testing
these
devices. • Due to what I think was a purely mechanical problem
caused by a hereditary narrow chest compressing my heart, I had a 95%
RIVA-stenosis back in 2001 with a bare metal stent implanted which remained
100% open
ever since. Yet as the endothelium had probably been injured during insertion,
bad scarification had slowly built up to a new 75% stenosis by March
2008, when a second stent, of the drug-coated type (Xience), was implanted
shortly
upstream of the first one. By July 2009 a 65% in-stent restenosis had
developed within the Xience stent despite the (astonishingly enough needed)
co-medication
(75mg Plavix) still ongoing since March 2008. Hence, I suspect the following
bad joke being played on all carriers of drug-coated stents: the coating
might not have been designed to improve embedding but to accelerate clogging,
rendering the patient completely dependent on the expensive clopidogrel
(Plavix) designed in turn as the only effective antidote. Multinational
corporations being notoriously suspected of strategies used by organized
crime, we need another insider like tobacco industry's Jeffrey Wigand
to come out with
the large-scale frauds of the pharma lobby. • RJ in Florida -- the question is if you have symptoms
(pain, breathing difficulties, etc.) and also if the semi-blocked stent
is causing ischemia (lack of blood flow/oxygen going to the heart muscle).
Normally blockages are not treated when they're below 50%, but there are
other ways of measuring functionality in the artery (see "Fractional
Flow Reserve") • Hello, just underwent a diagnostic angiogram to
check my DES stents. Dr said that one in the RCA was 40 percent blocked
by scar tissue. When would they
do something about this, and how would they go about it? I am going off plavix
for 2 weeks for a surgery next week. Thanks. • I had the Liberte' Monorail stent placed in my
LAD, March 2009. went on Plavix and ecotrin aspirin, along with other meds
for diabetes & hypertension. Now August 2009, went back in hospital with
same symptoms as back in March, found stent to be 99% blocked, a PROMUS
coated stent was placed and now the Doc wants me to start on Effient. Any
thoughts? • EH -- check out our Patient
Guide to Heart Tests.
A nuclear stress test is non-invasive and shows how well blood and oxygen
are flowing to the heart. But it can yield false positives and negatives.
A multislice CT angiogram is also non-invasive, but to see "inside" stents
can only be done in optimum situations with the very latest high-res
equipment and operators trained in these techniques. Both of these tests
do use radiation. A simple coronary calcium score exam, also done with
CT but a a much lower
radiation
dose, can show the amount of calcium and while it doesn't show the specific
artery, it can be a low-cost indicator of major coronary disease. Ask
your cardiologist for his/her recommendation. Hopefully you do not have
the title of this Forum Topic, "In-Stent Restenosis". Also
congratulations on following the lifestyle diet and exercise plans!! • I had three stents in the major left artery
approx. 10 years ago. What are the options for taking a look at them
now? Is a catheterization the only way?I have some discomfort in my chest
at
times. I also follow a very healthy diet and exercise program - Ornish
and Fuhrman. However, I do realize that stenting is not the long term
solution to this problem and I would very much like to have a non-invasive
test
done if such a thing is available. • JA -- if you read through this topic you will
see that stents that have reblocked can be reopened using a balloon, and
possibly another stent that is placed inside the blocked stent. This is
technically "off-label" but is the most common way that in-stent
restenosis is treated. • My dad had a stent put in four years ago. The
doc would have rather done another bypass but none of my dad's veins were
good enough to use. He is now having more chest pains and pressure. Can
a stent be restented (not sure how to ask this)? Thanks. • I am a 41 year old woman I suffered a Heart attack
in February 09 I was flown to Hospital and had 60% blockage in the LAD
they placed a bare metal stent in, I was put on a few different tablets
one being Plavix for 6 weeks,1 week stopping the plavix I started to get
pains in my chest out of breath and burning I went to the Doctors 3 times
and told him something wasn't right I was eventually flown to hospital
once again I was found to have 95% blockage after only 2 mths! and had
2 drug eluding stents placed in the LAD I am terrified of another blockage
I am a mother of 6 wonderful kids and I am so scared of my life being a
short
one. How did you all cope with your feelings after your events. • My husband has two DES placed in RCA that was
100% blocked February 27, 2009. No complications. Feels wonderful. He
is 55 YO, does not smoke, is not overweight He takes Ticlid (and an army
of
other drugs) as he was allergic to Plavix. How do you know if the stents
become clogged or blocked? Most info/comments are negative in nature
as to how well stenting works. Can anyone share any positive experiences
with
DES? • Hey Dan from Canada, I have had the same problem
as you. I had a drug eluting stent put in back in Sept. 2007. I kept having
some problems off and on so I went back in May 2008 and had another cath
done. They said the stent was blocked about 30%. Thing continued to get
worse so I went back Jan. 2009 and that same stent was now blocked 90%.They
put a different stent inside that one and things were better for a few
days. I still have some discomfort from time to time and my feet and legs
swell really bad every day. I am taking lasix 40mg. Helps some but not
a lot. I still get short winded when I do physical activity. • My dad, age 75 had bypass surgery in 1991. Last
year (October 2007) it was discovered that one of his bypasses had a
90+% clog so a Cypher bare metal
stent was put in. In Feb 2008 he had to have a Cypher DES placed in the same
artery. In May, the artery was already 50-60% blocked again, the Cardiologist
wanted to use the wait and see approach to see if further clogging occurred.
Last week (August 2008) the same artery had a 80-90% blockage so a bigger
Taxus DES was placed this time. He has been on Plavix and Aspirin since
October 2007
and not ever been off of it. The doctor says this will be the last stent
he places and the next time (if this happens again)would be bypass again.
His heart is
in otherwise good condition. Apparently this artery is an important one.
My
family and I are wandering what could cause this same artery to become
blocked so quickly.
His Cardiologists is always in a hurry and doesn't take time to explain anything
to us. It doesn't make sense that plaque would build up in just this one
artery in such a short a period of time. Why wouldn't other arteries be
blocked if
this were the case? • How can a doctor check for in-stent restenosis?
1 in 4 who had stents prior to the medicated stents being available had
scar tissue grow over them and block them. My sister went to the doctor
for shortness of breath, etc. just 3 weeks ago. Today she is brain dead
and in the CCU because a stent was blocked. • I have had 5 angioplasties and 7 stents -- the
last 2 on March 11th due to restenosis in two previously implanted stents.
The cardiologist used 2 Taxus stents as the previous ones were Cypher stents
and put me on Pletal® [Cilostazol] for 1 month to help prevent restenosis.
Feel pretty good after 1 month from procedure. Has anyone else had similar
situation.
I am also a diabetic. • C.M. -- this is called in-stent restenosis --
the situation where a stent gets blocked up. It's not common, but it
definitely happens and it is typically treated by reopening the blockage
with a balloon
and sometimes putting in another stent, usually a drug-eluting type,
which has less tendency to block up again. Do you know what type of stent
you
got originally? Bare metal or drug-eluting? • i had stent fitted 6 months ago, then last
week i had to have another
one
fitted in the same place. Is this normal? • Hi Mary and Dan, I have been reading your
post, My right was 90% closed when I had my first stent inserted, I
felt great for about a week and a half, then things just started going
down
hill, but I couldn't get anyone to listen to me, because I should have
been feeling great they say, This went on and on, I started becoming
so tired my eyes would close, automatically, then I started getting
cold, I couldn't warm up, I was freezing for days, but there was nothing
wrong.
I woke up one morning to have coffee with my husband, and before I
could say good morning, I was in a full fledged heart attack. My bare
metal
stent had closed off on one side with scar tissue, so I had another
inserted, this time a drug eluting stent, to help avoid the scar tissue.
Do I feel
better now, This was done in January, 2008, but now I don't feel good,
my biggest thing is the heart burn I have had now for the past three
days, I started having this problem, off and on since my last stent,
but now I have it all the time, along with a cough, it is so annoying,
I have a lot of chest pain, but I am told its probably from the heart
burn, I guess the pain I have in back is caused from the heart burn
as well, when my hands and feet go numb with pins and needles it's caused
from my heart burn as well. I find I am right back t where I started
from, I don't feel well, but no one will listen until it's too late. • My mom just turned 70 in aug. When she was
49 she had a heart attack. Her main artery was blocked 100%. This past
april she had a spell that put her into the hospital. they put five stents
into her main artery. they put her on plavix and topiral. she was allergic
to topiral. five weeks later stress test show something not right. did
another heart cath. four of the five stents closed they replaced those
with medicated stents. my mom has been so sick with her stomach and weakness
and her teeth have her so much pain shes been in the er 4 times times
this week. monday she is scheduled to have 4 teeth pulled with being
on the plavix. i am so scared for her. on top of this my dad is having
surgery on his bladder there is a mass we dont know if it is cancer.
someone email me please. • Had a stent put in in May, 2 months later
I started getting angina even while at rest, it became so severe(the
angina) that my wife drove me to emergency, where next day I underwent
another angiogram to see what was wrong, the stent had blocked to 90%
(all in two months) the cardiologist inserted a new drug eluting stent
inside the old one. I feel great now except that every evening my ankles
and feet swell up, then are OK next morning. .anyone else get this problem?
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