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Current Postings on This Page (41):
• 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.
Pam Baker, Illinois, USA, August 4, 2010
• 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
Diana, St. Petersburg, Florida, USA, July 20, 2010
• 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.
Forum Editor, Angioplasty.Org, July 19, 2010
• 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.
Kalyani, Sri Lanka, July 19, 2010
• 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.
Forum Editor, Angioplasty.Org, April 27, 2010
• 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).
A concerned wife!, Upstate New York, USA, April 26, 2010
• 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.
Forum Editor, Angioplasty.Org, April 26, 2010
• 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.
A concerned wife!, Upstate New York, USA, April 26, 2010
• 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%.
Forum Editor, Angioplasty.Org, April 26, 2010
• 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!
Elizabeth Mckee, Collegeville, Pennsylvania, USA, April 26, 2010
• 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".
Forum Editor, Angioplasty.Org, April 16, 2010
• 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
Elizabeth, Collegeville, Pennsylvania, USA, April 14, 2010
• 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.
Patrick , Orange, California, USA, April 14, 2010
• 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.
MR, Bangalore, India, April 4, 2010
• 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.
juc, Los Angeles, California, USA, March 16, 2010
• I recently went through restenting after seven
years without any problems. Scar tissue grew back in one year and was
98% blocked.
Rick, San Francisco, California, USA, March 10, 2010
• both drug coated stents are blocked. Causing stable
angina. what options are there to clear the occlusions. Please advise.
Wil, Nashville, Tennessee, USA, February 28, 2010
• 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.
Dee, Pennsylvania, USA, February 23, 2010
• 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?
LS, Cashiers, North Carolina, USA, February 10, 2010
• 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.
Forum Editor, Angioplasty.Org, February 10, 2010
• 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.
Ken, Perth, Western Australia, February 9, 2010
• 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.
Forum Editor, Angioplasty.Org, October 15, 2009
• 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.
OF, Switzerland, October 8, 2009
• 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")
Forum Editor, Angioplasty.Org, October 1, 2009
• 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.
RJ, Florida, USA, September 19, 2009
• 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?
John Doe, Anytown, USA, August 26, 2009
• 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!!
Forum Editor, Angioplasty.Org, August 17, 2009
• 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.
EH, Newfoundland, Canada, August 17, 2009
• 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.
Forum Editor, Angioplasty.Org, July 26, 2009
• 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.
JA, Minnesota, USA, July 13, 2009
• 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.
Kim, Australia, May 26, 2009
• 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?
GP, Kansas, USA, May 4, 2009
• 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.
Terri Waller, Atmore, Alabama, USA, February 11, 2009
• 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?
Cissy, Kentucky, USA, August 27, 2008
• 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.
HR, Topeka, Kansas, USA, August 14, 2008
• 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.
Jim Savage, Bank Officer, Staten Island, New York, USA, April 12, 2008
• 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?
Forum Editor, Angioplasty.Org, March 22, 2008
• i had stent fitted 6 months ago, then last
week i had to have another
one
fitted in the same place. Is this normal?
C.M., Great Britain, March 20, 2008
• 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.
Patsy, Nova Scotia, Canada, February 8, 2008
• 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.
mary venables, massillon ohio usa, November 17, 2005
• 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?
Dan Danaher, Saskatoon SK Canada, October 31, 2005
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