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In-Stent Restenosis

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Stents placed to keep an artery open can sometimes become re-blocked, called in-stent restenosis. Post experience and questions about In-Stent Restenosis here.

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Current Postings on This Page (120):

• The original stents were "drug eluting" stents as was the third one. I've never smoked and pay attention to diet and exercise as I can (shortness of breath and chest tightness interfere and have been told to "rest" when those occur). I do take my meds (FAR more than I'd like). The symptoms persist. Is there anything else that can be done?
Bowdenfan, Winder, Georgia, USA, July 6, 2013

• Bowdenfan - Obviously, and you probably already have done this, reduce all modifiable risk factors (smoking cessation, diet, exercise and adherence to prescription meds). We're curious as to which stents was originally used in the bypass graft, and which one was put in the second time. One new therapy that is approved in Europe, but not yet in the U.S. is a drug-eluting balloon. No hardware, such as another stent, is put in place, but the drug on the balloon may lower the risk of restenosis. Medtronic and several other manufacturers market products in Europe, but the jury is still out on their effectiveness.
Angioplasty.Org Staff, Angioplasty.Org, July 5, 2013

• I had 2-vessel bypass. Six months later, one of the grafts became occluded. 2 stents were placed. I became occluded and another stent was placed. I still have chest pain, shortness of breath and chest pressure but the cardiologist says the graft is too small to re-stent OR to bypass. Options for me??? Thanks
Bowdenfan, Winder, Georgia, USA, July 5, 2013

• Repeated Restenosis in India - We assume your father has been treated with the newest drug-eluting stents (which minimize renstenosis). Also is he doing everything possible to reduce his modifiable risk factors: smoking cessation, diet, exercise, medications?
Angioplasty.Org Staff, Angioplasty.Org, May 16, 2013

• My dad had undergone a bypass 15 years back post which he started feeling discomfort in 2011 for which we had been suggested angioplasty .Since then I have performed 6 angioplasties including 2 balloon angioplasties on my dad one as recent as on 4 May 2013. But there is frequent restenosis happening in his LAD. Can anyone please suggest an alternate course of action.
Repeated Restenosis, Swadhaar Finserve Pvt Ltd, Mumbai, India, May 10, 2013

• My dad was having an acute MI and he had a stent put in the RCA. A half an hour later his stent closed up and he was having another heart attack so he was back into the cath lab. Besides the fact that his stent might not of been expanded as much as needed what are other reasons this might happen?
Chris, New York, USA, April 18, 2013

• Zoltan in Hungary -- Even though your post is quite "off-topic" (nothing to do with in-stent restenosis) we feel your assertions need to be answered. You keep referring to the cholesterol "whammy", etc. You write that half the U.S. states prohibit stenting by law unless it replaces open chest intervention. We have no idea what you're talking about. None of this is even remotely true. Finally you have referred twice the "renowned" Dr. Dwight Lundell who, according to "Quackwatch" had his medical license revoked in 2008. In fairness, some of his ideas are probably correct, but his surgical practice has been questioned repeatedly. Should there be more emphasis on healthy lifestyles? Certainly, and no doctor would disagree. But modern medications and procedures are very important to control and treat heart disease.
Angioplasty.Org Staff, Angioplasty.Org, April 7, 2013

• Be careful with "clinical trials' evidence". Most of them founded and just driven by the Big Pharma. We're in the middle of a paradigm shift from the Ancel Keys cholesterol whammy to admitting the "sugar bomb's" destroying role. Furthermore, as far I as I know some half of the US states recently prohibited stenting by the law unless it replaces an open chest intervention... In the end always ask the question yourself whether there is a way to recover or are you condemned to stay chronically ill... and don't accept an answer w/o trying CAM, ITM/Ayurveda or CTM options. This does not degrade the great efforts or cardio surgery - that's why I referred also to Dr. Dwight Lundell... and many other renowned doctors say the same. Make your thoughts about this. Thanks.
Zoltan with 1x stent med. malpractice, Hungary, April 6, 2013

• Scaredwife in Ohio -- Your description of what happens when a stent is under-deployed, not optimally expanded, is completely accurate. It's one reason that we at Angioplasty.Org have been advocating for much wider use of technologies, such as intravascular ultrasound, to aid in placing, measuring and checking that stents have been optimally deployed. Read our articles and interviews with leading cardiologists in our Intravascular Guidance Center, especially our interview with Dr. Antonio Colombo who first discovered this problem two decades ago! It sounds like the new cardiologist is planning is to insert a new stent inside of the old one, and then expanding it, compressing the old one against the artery wall. We don't think they will be pushing it "off to the side" -- haven't heard of that. And while this technique is "off-label," it is the most common way to treat in-stent restenosis (ISR).
Angioplasty.Org Staff, Angioplasty.Org, April 6, 2013

• My husband had stent placed in Sept 2011 and went back to work in 6 weeks. Then in February started having chest pain and went in for another cath only to hear the stent was blocked and wasn't expanded completely when 1st put in so he has small amount of flow on each side. They weren't able to unblock it so he went in for another cath with a team and they couldn't unblock it. So now they are talking about compressing it off to one side and placing new stent beside it. But I have looked online and can't find any info on someone doing this. He also has like bubble blow outs in arteries.
scaredwifeof4, mom and wife, Eaton, Ohio, USA, April 1, 2013

• Zoltan -- We definitely support patients taking charge, managing their disease, and doing everything they can to reduce its recurrence, but we disagree with your statement that stenting, cholesterol, etc. is just "profit-driven malpractice hype." Death and disability from heart disease has been reduced and lives saved because of these advances in medical and interventional therapies. We also checked out the web site you recommended ( and found many many totally incorrect statements that are just not born out by fact or by any clinical trials. Like the assertion that, "In many cases, stenting needs to be redone/reopened every 1-4 years." The current figures for repeat procedures with second generation drug-eluting stents are in single digits, less than 1-in-10 patients. And the web site completely confuses restenosis with thrombosis: totally different causes; totally different treatments and outcomes. And so on. In fact, it's interesting that the web site seems to exist to sell several books written by "Mike Stone", who is also listed as the owner of this web site, located in Ma'ale Adumim, an Israeli settlement located in the West Bank. Mr. Stone even credits Hadassah Hospital with saving his life from a heart attack, but then goes on to defame the whole field of interventional cardiology.
Angioplasty.Org Staff, Angioplasty.Org, March 31, 2013

• Hi. Reading this posts is sad and makes one depressive. I strongly suggest that you check what actually might have caused your status and what real options there are. Stenting and the cholesterol hype is just mainly profit driven stupid malpractice which harms. Check what senior heart surgeon Dr. Dwight Lundell or heart specialist Dr. Crandall says in plain English, check Hawthorn and Amlaki (Indian Gooseberry) and the successful healing report on Do you want to prevent or recover instead of being "treated"? Use common sense. Google. Get healthy.
Zoltan with 1x stent med. malpractice, Hungary, March 30, 2013

• LisaR in Houston -- Sounds like you suffered an acute stent thrombosis (blood clot inside of stent < 30 days after the procedure). It may have nthing to do with the stent itself, but may be that you are one of those people who are clopidogrel non-responders -- that is to say, this drug (brand name Plavix) did not do its job to prevent blood clots (see our interview with Dr. Eric Topol about this issue). Effient (prasugrel) performs the same job, but works differently than clopidogrel and doesn't have the non-responder issues. As for your PTSD, you are not alone. A recent study showed an increased risk for PTSD in heart attack patients -- only logical since the words traumatic and stress are certainly descriptive of a heart attack, and your situation in particular. Hopefully you can get some counseling or therapeutic help in dealing with this. You've dealt with so much already!
Angioplasty.Org Staff, Angioplasty.Org, March 28, 2013

• In late January 2013, severe upper back, shoulder/dual arm pain brought me to closest ER. Heard Code Blue. A beeper brought an Interventionalist at 3:00AM. Was told there was a large clot at the top of my LAD blocking flow. Called it a STEMI. Medtronic stent placed. Sent home the next day with generic Plavix, daily baby aspirin. Tylenol if needed and told not to take antiinflammatory meds again.(took Advil almost daily). Thought I was fixed but 27 days later at 4:00AM same pains hit me. 911 will not take you to the large heart center so hubby did 90 mph and drove to the heart center. I was rushed to the Cath lab within minutes and a Xience Expedition was placed. The clot had returned again in the top of the LAD. The Medtronic earlier stent from the smaller hospital, 27 days earlier, was ballooned. Heart Center took me off Plavix and put me on Effient along with baby aspirin. I am scared as it's now 20 days with the Xience & Effient and wonder if this will close up too in another week. I have damage from 2 STEMIs. Interventionalist at heart place said this is now fixed. I am having PTSD from 2 major recent heart attacks and wonder how this could happen. I stay up all night now waiting....
LisaR, Houston, Texas, USA, March 19, 2013

• End to end stents can be at somewhat higher risk for restenosis, due to an edge effect. For more about this, see our recent article regarding the new longer length stents just approved by the FDA. As for how long it takes for the stent struts to be covered by endothelial cells, OCT imaging studies have shown varying amount of times, depending on the stent, polymer, drug, etc. The ODESSA study by Dr. Giulio Guagliumi showed that at six months the Endeavor (Medtronic) stent was completely covered, while the Cypher and Taxus (first generation stents) were not yet. Recent studies have shown much lower restenosis and thrombosis rates with the second generation of drug-eluting stents (like Xience/Promus and Resolute Integrity). For any drug-eluting stent, guidelines recommend one year of dual antiplatelet therapy (this is aspirin plus a thienopyridine, such as Plavix, Effient or Brilinta).
Angioplasty.Org Staff, Angioplasty.Org, February 27, 2013

• I had two Xience V stents placed in my RCA - a 22 mm stent over a hard lesion (90% blocked) and a second 13 mm stent next to the first due to a proximal tear caused by placement of the first stent. I am assuming that the lesion only covers less than 22 mm of the 35 mm effective length of the combined stents. My concern is the length of time for the endothelial layer to grow over the struts. I saw one study which suggests the new cell layer grows from the ends, which means it takes quite a bit longer for long stents, and therefore means I should be on Effient longer than a year. In this case, the shorter stent may be covering a lesion, so the cells may grow up through the struts instead of the end, correct? What is the guidance for length of time to take Effient for back to back long stents? Is the likelihood of thrombosis or restenosis much greater for the end to end stents? thanks
Peter, Crystal River, Florida, USA, February 27, 2013

• Shari -- We assume you got the figure of 79% from an angiogram that was done 7 months after the stent was placed? It's hard to say exactly what that means if the measurement is from the angiogram only. Strictly speaking it means that about 20% of the artery's diameter has filled in, but that may have no bearing on the blood flow through the artery, unless an FFR measurement was done. It is normal for endothelial tissue to grow over the struts somewhat. What did your cardiologist say about this?
Angioplasty.Org Staff, Angioplasty.Org, February 22, 2013

• My stent is only working at 79%, what exactly does that mean. It is only 7 months old.
Shari, Stouffville, Ontari,o Canada, February 22, 2013

• Jay in Seattle -- Currently no drug-eluting balloon (DEB) is approved for use in the U.S. The IN.PACT, made by Medtronic, just completed an important study and is probably closest to FDA approval, but that's a year or more away at best. And even then, the official approval would be for use in peripheral disease, not in-stent restenosis. DEBs are currently available in Canada and Europe, however, and a recent meta-analysis published last month in Heart, concluded

"In-stent restenosis is the bane of coronary angioplasty, and drug-eluting balloon angioplasty is a promising treatment option in this situation. It reduces the risk for MACE compared with plain balloon angioplasty or implantation of a Taxus Liberte drug-eluting stent."

Angioplasty.Org Staff, Angioplasty.Org, February 17, 2013

• Is the Drug Eluting Balloon angioplasty available as a treatment option for in-stent restenosis in the USA or Canada? I have suffered restenosis 3 times in the past 2 years, most recently after treatment last year that included placing PROMUS Element Plus stents inside of the original Endeavor Zotarolimus stents.
Jay Seattle, Seattle, Washington, USA, February 16, 2013

• Dear In-Stent from India -- Diabetics are at heightened risk for restenosis. And a bifurcation stent is also a restenosis risk. Putting the two together and it's not too surprising that he restenosed. We know that recently the Medtronic Resolute stent was approved by the FDA in the U.S. specifically for diabetics. We would hope that your father's cardiologists used this or an equivalent second generation stent. One option is to reopen the closed stents with a balloon, possibly a drug-eluting balloon. These devices are not yet approved in the U.S., and we're not sure about India. We don't think his gastric problems are heart-related, however. More likely they may be due to his medication. In any case, we can't really give medical advice; moreover, your father is definitely a complex case, so you should discuss these issues with his cardiologist. We also hope that your father is doing everything he can to reduce his risk factors (smoking, diet, exercise, etc.).
Angioplasty.Org Staff, Angioplasty.Org, January 10, 2013

• Hi, My father 56 years of age, a 15 year diabetic patient, had undergone angioplasty once in 2009 for LAD with 95% blockage and in-stent restenosis happened within 1 year. Went for Bypass surgery in 2010 and LAD is good till now. Recently in May 2012, he was diagnosed with LCX and OM occlusions and has undergone angioplasty with bifurcation stents (DES). Within 2 months blockages are reformed (in-stent restenosis) with total occlusion in OM1 and sub-total occlusion in LCX again. He gets heartburn and pain in the chest after 5 mins of walk and then it will subside in 3 mins if he takes rest. If he continue walking pain increases. He gets continuous burps when there is heartburn. Recently, the burps started more even in the morning, after eating food and while lying down on the bed. The heartburn cools down after taking gelucil (acidity) or by sorbitrate. We even tried chelation therapy and EECP but no relief from the pain. We are worried to go for another stent as it may get blocked again. We are unable to determine if these symptoms are because of in-stent restenosis or because of acidity. How important is LCX? Stent again is advisable? way/treatment to prevent in-stent restenosis?
in-stent restenosis, Bangalore, India, January 4, 2013

• Tin man's heart in Wisconsin -- So sorry to hear of your husband's travails. He is, as Dr. Paul Tierstein of Scripps calls it, a "frequent flier". Coincidentally, also at Scripps in La Jolla is Dr. Eric Topol. He discusses the CYP2C19 issue in his interview with us.
Angioplasty.Org Staff, Angioplasty.Org, January 4, 2013

• My husband had Bypass graft x5 with 4 of the grafts closing within a week. He was tested for Plavix reactivity and was negative. Long story short he has been to the cath lab 19x in 17 months and has 19 stents. @ bare metal and 17 drug eluting. He has had an infarct and has a fixed apical defect. He has received brachytherapy to LAD and has 6 stents in that area. He has stents inside of stents and has just gone back into hospital with same symptoms prior to his OPCAB surgery. His last two trips to cath lab were for thrombus beyond the stent and balloon angioplasty. Did research and feel he may have genetic CYP2C19, which treats Plavix as Placebo. He was recently switched to Effient and we were hopeful. My husband is 52, non smoker has made all lifestyle changes as far as diet and exercise. Cholesterol normal, non diabetic, thin. His EF is 45-50% so does not meet transplant requirements. They did an ECHO today and plan on LEXA scan tomorrow. All other stents have been open except for LAD. We have cardiologists shaking their heads. Have also seen cardiologist at University re: stem cell for coronary regrowth i.e.: collateral flow. Enzymes and markers neg.
Tin mans heart, Wausau, Wisconsin, USA, December 27, 2012

• 90% in-stent restenosis - angioplasty done 7 years back. Now angiography done which showed 90% blockage at beginning of stent placed earlier.
Opinion reqd, abc, Mumbai, India, November 11, 2012

• MDM in New Jersey -- Patient Forums tend to be "complaint departments." That's good, in that patients are able to communicate with each other and see that they are not alone with certain issues. But you can't judge the success of a treatment by the number of negatives you'll see here. The big statistics are that restenosis (reblocking) at one year with drug-eluting stents is down to single digits -- so the chances of a durable and successful outcome are greater than 90%.
Angioplasty.Org Staff, Angioplasty.Org, October 29, 2012

• My dad is scheduled for 2 DES stents and from reading all the posts it seems that there is nothing but problems with the current procedure/technology. My question is can someone that does all the right things after the stent procedure, for example take their med's, proper diet and regular exercise, is the prognosis for a normal life span? The Dr keeps saying the stents won't prolong his life and I'M NOT SURE WHAT HE MEANS. THANK YOU.
MDM, New Jersey, USA, October 11, 2012

• bike69 -- It's not that the combination of Plavix and Celebrex is necessarily bad, although you need to be careful of gastric upset and/or bleeding -- but that Cox-2 inhibitors have been implicated in increased occurrence of heart disease. The most well-known example was Vioxx. Celebrex less so than Vioxx, although a recent study showed naproxen (Aleve) to have to lowest correlation with heart disease.
Angioplasty.Org Staff, Angioplasty.Org, September 30, 2013

• I have been on Plavix for 3 years and Celebrex for two years without complications. Without the Celebrex my pain increases dramatically over time. I am a avid cyclist, riding 120 miles each week, swim once a week and try to do my Pilates or yoga once or twice. I am a nanny for a 7 year old, garden, and have an active dog whom I walk 4 times a week for a mile or so. How safe is my Plavix and Celebrex combination? I am a 70 yr old euroamerican female.
bike69, California, USA, September 24, 2012

• Patients must be educated! Cardiologists are great but they are heart doctors! I was uneducated and let mine put a stent in my leg when the stent failed I required a full bypass by a vascular surgeon! If its not in the heart then don't see a cardiologist see a vascular doctor.
Devastated patient, New City, New York, USA, September 20, 2012

• My dad has had another stent put in yesterday. This makes #27, yes 27. Some stents in stents others are solo. He was sent home with still an artery blocked 80% and told to come back in 2 weeks to get that one stented also. Five months ago he was stented in 2 arteries. It happens fast and sometimes slow. He now has it down where he feels only pain in his shoulder only, that's when we go. My question is when is enough , enough? Why not bypass? How many is too many? PLEASE help!!!
Marisa, Galveston, Texas, USA, August 30, 2012

• 2 stents were placed about a month back. No problem so far. I am a diabetic on insulin, but glucose levels under control. Only problem is my bp readings from an Omron meter is in the range of 130/80 to 150/90. Are they safe levels? My lipid levels are quite normal with total cholesterol 90 and HDL 43. please someone enlighten me if I'm in any risk.
Rao from india, Retired from teaching profession, Vijayawada, India, August 13, 2012

• Just to clarify what I have had done. 1998 after heart attack, stent was placed in LAD. May 2011, went to ER with chest pain. Doctor said stent had collapsed. Put in new stent to reopen LAD. Used Xience V stent. Took Plavix and aspirin daily plus Crestor and metoprolol tar. June 26, 2012 had chest pain and tightness. Since going on vacation soon went to Dr. to make sure all OK. Dr. put me in hospital and sent me to cath lab right away. Put another stent inside to open other stent. Now 3 in 1 place. Used a Xience. After finished with stent, DR. asked where the last stent was put in. Said it looked like the last stent in 2011 wasn't opened fully because it was tapered in at one end. But my cardiologist said the next morning that it was restenosis then explained what is was. Didn't mention about the possibility that Plavix not being effective. I am worried after reading some of these comments that I may be having this as an annual event.
Don D, Phoenix, Arizona, USA, July 7, 2012

• Don D in Arizona -- It's not clear from your post what happened with the new DES stent. Did it get re-opened? And why did the cardiologist who placed the new stent a year ago think that it hadn't opened correctly? What evidence did he offer? In-stent restenosis is a real problem, one of the last that needs to be solved in the stent era. What is important clinically is to determine exactly why the stent closed up, so the treatment can try to address that specific problem: was it not placed correctly, not opened fully, did it actually fracture or physically collapse? Restenosis is not a "collapsed stent", but the regrowth of tissue inside the stent. Treatment ranges from re-ballooning the stent to fully expand it, sometimes with a balloon that is coated with drugs (although not approved in the U.S.), to increasing the antiplatelet therapy, to putting in another stent. As for DES stents, they are much less likely to restenose than bare metal stents. And glad you stopped smoking! That's a very big risk factor for coronary artery disease.
Angioplasty.Org Staff, Angioplasty.Org, July 7, 2012

• Had heart attack in 1998. Had stent placed in LAD. In May 2011, went to hospital with chest pain. Stent had collapsed with 80% blockage. Restented with des. 1 week ago, chest pain again. Same stent. Doctor who placed new stent mentioned he thought stent wasn't opened correctly. Next day my doctor said it was restenosis that closed it. Took Plavix all the time until about a week before the last event. And aspirin everyday. Quit smoking 4 years ago. Try to watch my diet but very stressful job. Fearing now that I will have the same problem every year now. Afraid of des stents. The bare metal stent lasted so long. And as a side note, haven't paid all the bills from 2011 and now will have more bills to pay. Thus even more stress.
Don D., Phoenix, Arizona, USA, July 7, 2012

• Hammad in Saudi Arabia -- First off, the quoted percentage of drug-eluting stent restenosis is an average. Certain types of blockages, as well as location, lengths, etc. may be more prone to restenosis than others, so it's just an average. That being said, it also depends on the exact study you are looking at for a particular stent. The recent TWENTE Trial showed that clinically driven target vessel revascularization (TVR -- a new procedure was required to re-open a blocked stent) within the first year was around 3% for both Medtronic's Resolute and Abbott's Xience. First generation DES such as Taxus and Cypher have higher rates, but all are at or below 10%.
Angioplasty.Org Staff, Angioplasty.Org, July 4, 2012

• What is the percentage of restenosis after 11-12 months with DES?
Hammad, Riyadh, Kingdom of Saudi Arabia, July 4, 2012

• Rusty -- Inserting a new stent inside of one that has become reblocked is the standard treatment for this event.
Angioplasty.Org Staff, Angioplasty.Org, July 3, 2012

• I had a stent placed into an original stent which was 80% blocked just a couple of days ago. Had never heard of this procedure before. Very uneasy that this was done. Should I be concerned?
Rusty, Monterey, Virginia, USA, June 29, 2012

• Donna in Arizona -- Angiograms, angioplasty and stents are all catheter-based procedures -- not surgery. They are performed in a catheterization lab. Bypass surgery requires an OR with a completely different set of equipment and personnel. So the bypass would not be done in the same procedure, although they may schedule him shortly thereafter, if they feel it's urgent to do. As for stopping aspirin and Plavix, patients should never stop these drugs without an okay from their interventional cardiologist -- these drugs prevent the blood from clotting inside the stent while it is healing. Finally, if a stent is blocked, there are several ways to re-open it. One is to place another stent inside (he's already had that done in one area). Sometimes a balloon is inflated inside the stent -- and recent European trials have been testing a drug-coated balloon with good sucess -- but that is not yet approved for use in the U.S. As for alternatives to a PCI (percutaneous coronary intervention, a.k.a. angioplasty) the only way to remove the effects of a blockage is to open it up with angioplasty, or to bypass it, with surgery. And really, these blockages only need opening if they are "ischemic": i.e., causing a problem like restricting blood flow to the heart in a way that causes pain, or other adverse condition. We assume your husband is doing everything he can to reduce other risk factors, such as stopping smoking, diet, exercise (if possible), etc.
Angioplasty.Org Staff, Angioplasty.Org, March 31, 2012

• My husband had 6 stents (actually 7 they had to use one inside another) 16 months ago in his left coronary artery and a mild heart attack (he also has 2 stents in his right artery, done several years ago) -- he recently had a chemically induced stress test and at rest showed signs of a blockage. They are going back in to do an angiogram, are there any procedures left other than bypass -- He has been having some pain/discomfort at rest, even sleeping. We are obviously concerned and also are waiting to hear if he should stop his aspirin or Plavix before the angiogram next week, and do they usually do a bypass if needed at the time. His doctor had a leg injury and we are waiting for him to call us, since he does not have any office appointments available before the procedure next week. Thank you for any information you can give us.
Donna, Arizona, USA, March 29, 2012

• MC62 in New York -- Very sorry to hear. You say the 100% blockage after 7 days was "restenosis", which is the excess growth of tissue inside the stent. This usually takes several months to occur, if it's going to happen at all. We're wondering if it might have been "stent thrombosis" instead, which is a sudden and acute clotting of blood cells inside the stent. It may be that you are what is known as a non-responder to clopidogrel (Plavix) so the Plavix, along with aspirin, wasn't doing its job of keeping the blood from clotting. For these types of patients, switching to Effient (which works differently) is a definite alternative. Unfortunately, the only way to know if you are a non-responder is to do a genetic test or a platelet reactivity assay, neither of which are done routinely in most hospitals. To read more about this issue, see our interview with Dr. Eric Topol. Of course, this only applies if your blockage was actually stent thrombosis. If it wasn't, our only other thought is that there may have been some issue with the stent placement or stent integrity itself which caused an acute blockage. What type of stent (name, manufacturer, etc.) did you get? Finally, regarding the New York Times article, we posted a commentary yesterday about this study. There's not a lot of controversy about opening up an 85% blockage in the LAD (the main artery for the heart) even among cardiologists who are on the medical therapy side, but you unfortunately had a relatively rare but very serious complication occur.
Angioplasty.Org Staff, Angioplasty.Org, February 29, 2012

• Active male age 49, had medicated stent implanted 1/2012 in LAD to alleviate 85% blockage. I felt great, but seven days later stent became 100% blocked (restenosis) while exercising; heart damage occurred before doctors could clear it out with another angioplasty. Doctors don't know why it became blocked, but I have been switched from Plavix to Effient for an anti-coagulant drug (plus other medications). A New York Times article was published yesterday stating "No Extra Benefits Are Seen in Stents for Coronary Artery Disease". I sure wish I had read that article first.
MC62, New York, USA, February 28, 2012

• Mahesh in India -- Sirolimus is a brand name for rapamycin, so they are the same drug. The other limus drugs are very similar -- what seems to be the difference is the stent design structure, thickness of struts, etc. and the polymer itself: how biocompatible it is, how quickly or slowly it elutes the drug.
Angioplasty.Org Staff, Angioplasty.Org, February 9, 2012

• Dear All, I have been working as a sales representative in an Indian medical device company and I have been selling Rapamycin Eluting Stents. But now a days, I have been coming across some of my physicians who have some apprehension about the efficacy of Rapamycin over the other limus family drugs like Sirolimus, Everolimus, Zotarolimus...I'm looking an experts advice over the issue and how do I answer this. May I personally request the panel for some credible article in supporting. I'll be more than obliged with your help. Thanking you. Regards, Mahesh
Mahesh, India, February 8, 2012

• 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
PDW, Colorado, USA, December 29, 2011

• Annie, Heidi et al -- A comment on your question "to fix it or just relieve it" -- all that angioplasty and stenting does in non-emergency situations, is to relieve angina -- it's not a "fix" per se, because it doesn't halt the progression of coronary artery disease. Patients need to minimize that progression by changing lifestyle (stop smoking, diet, exercise, etc.) and also staying with the prescribed medications. But certainly for a "frequent flyer" like yourself, this problem can be depressing at best! Dr. Paul Tierstein of Scripps has written about this issue in particular. If you think you're stent may be restenosing, see your cardiologist and there are some noninvasive tests he/she can run before going to an angiogram.
Angioplasty.Org Staff, Angioplasty.Org, December 29, 2011

• 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.
Annie, Glendale, Arizona, USA, December 28, 2011

• Hi, My husband had by-pass surgery 2 and 1/2 years ago. Last month he had an angiogram because of angina. They put in a medicated stent (1), but said he had 10 new blockages (most greater than 70%) and one of the bypasses is 100% reblocked. Why would they not stent the other blockages? We have been told that repeat by-pass surgery is not an option. He is booked for a nuclear test next month. Any answers would be much appreciated, thank you. :)
Heidi, Calgary, Alberta, Canada, November 15, 2011

• I had a heart attack in June and a stent was inserted. One month later had to have another stent and angioplasty done. After 4mos. stents clogged and then had open heart surgery and a double bypass, within 3 days one of the bypasses had collapsed. They say the other is good but I wonder what the chances are the other one will work and why all this happened so fast stents and all.
Judy, Ohio, USA, November 14, 2011

• 42 year old male no family history, non smoker, athlete, ice hockey player professional brief period, had heart attack Nov. 10', 2 stents LAD Abbott medicated brand, circumflex angioplasty done as well. Went to clinic Sept. 10' because of throbbing pain in throat and headache when running on treadmill, became so bad had to stop running, even just casual walk throat would act up, doc at clinic told me she thought I had asthma and gave albuterol which I did not use much, though day of heart attack took one puff and head felt like it exploded. Question upon arriving at hospital I drove myself ER Doc gave me nitro paste after tests and blood work. My heart attack had subsided and breathing became clear. Do you think that there could have been option to treat my problem with meds to see if could correct on own ? Currently taking metoprolol, simvastatin which caused severe muscle cramping stopped taking switching to Lipitor, Plavix & 325 mg enteric aspirin. Understand the psychological problems people feel from both surgery & meds. Exercise 4/5 times a week. Feel body needs rest after though, tired feeling. Think it is the meds?
2stentboston, Boston, Massachusetts, USA, September 17, 2011

• my husband had a stent 1 yr ago, has had ongoing angina weekly. Cardiologist says nothing is wrong, seen a natural therapist today who ordered a blood test for calcium and vit D, calcium was 17, vit D low, turns out after further scans he has tumor on parathyroid gland which is making excessive amounts of calcium, surgery to remove it next week. Also found out plaque is 3% cholesterol, 50% calcium, it will not calcify or cause plaque unless you have too much calcium. All of you go and get a blood test for calcium I think anything over 9 is dangerous and can go on to lead to a stroke or heart attack. If test is over what it should be you need to see a competent endocrinologist. He is a doctor who specializes in glands. I am praying this will be the end of his heart problems. Remember cholesterol will not form plaque unless it is in the presence of too much calcium.
Maria, Perth, Washington, DC, September 11, 2011

• Okay after looking at my old medical records, i see where last year after complaining of chest tightness and weakness that my cardiac cath showed a 70% in stent stenosis in mid left anterior descending ?...I had been told all was normal....recently having new symptoms of chest tightness, nausea, weakness and tiredness!!! Any reason why no intervention taken due to my history (had a ventricular fibrillation in 2007 with cardiac arrest and placement of stent in right artery) Taking my records to new cardiologist....we moved out midwest but i am pretty upset worried my symptoms mean more blockage?
happymom1, Tulsa, Oklahoma, USA, August 1, 2011

• In March 2010, I had a drug emitting stent inserted to prevent a "widow maker heart attack" in the top of the LAD with a 90% blockage. I started walking and improved my diet and lost weight. My cholesterol is normal now. I have noticed some slight chest pain when I walk up hills, so I walk on level terrain, but have not complained to my doctor. Now, my insurance company is forcing me to change from Effient to Plavix. I am afraid to undergo another angioplasty as a friend died last year during the procedure.
Sandy in Georgia, Blairsville, Georgia, USA, May 22, 2011

• my son has a stent that they inserted in feb. 09, he has cad, chf, hypertension and 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!
Sheila, Florida, USA, April 16, 2011

• 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.)
Angioplasty.Org Staff, Angioplasty.Org, April 15, 2011

• 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?
Elizabeth, UK, April 15, 2011

• 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
Linda b, Minnesota, USA, April 8, 2011

• 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.
D Wilson, Douglas, Georgia, USA, February 1, 2011

• 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.
Mertyl, Brisbane, Australia, January 7, 2011

• 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.
Angioplasty.Org Staff, Angioplasty.Org, December 23, 2010

• 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?
Bob B, Irvine, California, USA, December 13, 2010

• 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.
PH, Mexico, December 12, 2010

• 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.
Angioplasty.Org Staff, Angioplasty.Org, December 12, 2010

• 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.
PhilR, Port Elizabeth, South Africa, December 9, 2010

• 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:

"[DES] restenosis rates are related to the complexity of the lesion and clinical risk factors. In simple lesions, one can expect restenosis rates of less than 5% at 1 year. At 5 years, repeat intervention rates are approximately 10%."

Regarding patients, he urges physicians:

"Do not underestimate the emotional impact of repeated procedures on patients, particularly the “frequent flyers” who have experienced multiple visits to the catheterization laboratory. These patients often describe significant frustration and fear. They feel a loss of control, mostly due to an inability to plan their lives and predict when a restenosis will occur. It is helpful to reassure these patients by emphasizing they do not have an incurable, lethal disease.... Patients can be told if they stay in close contact with their cardiologist, the risk of death and infarction is low.... It may sound obvious to the physician, but most of our patients are seeking this kind of reassurance.... I also emphasize that recurrences are unlikely to go on forever. Finally, it is worth communicating that they are not the only patient to encounter this problem, and ultimately, patients with restenosis who seek treatment usually have good outcomes."

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.
Angioplasty.Org Staff, Angioplasty.Org, October 18, 2010

• 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?
Melanie, Vinita, Oklahoma, USA, October 18, 2010

• 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.
Red, Baltimore, Maryland, USA, September 29, 2010

• 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.
jackie b, Yucca Valley, California, USA, September 25, 2010

• 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.
Louise D., Hopedale, Massachusetts, USA, September 14, 2010

• 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?
Diane Harris, San Jose, California, USA, August 31, 2010

• 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.
Angioplasty.Org Staff, Angioplasty.Org, August 19, 2010

• 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?
Charlie C, London, United Kingdom, August 19, 2010

• 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.
Angioplasty.Org Staff, 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

• 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.
Angioplasty.Org Staff, Angioplasty.Org, June 24, 2010

• 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.
Puzzled, Texarkana, Arkansas, USA, June 14, 2010

• 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.
Angioplasty.Org Staff, Angioplasty.Org, June 13, 2010

• 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....
WENDYLNG, Englewood, New Jersey, USA, June 10, 2010

• 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!!
Dan B, Altoona, Pennsylvania, USA, June 9, 2010

• 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.
Craig R., Atlanta, Georgia, USA, June 1, 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.
Angioplasty.Org Staff, 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.
Angioplasty.Org Staff, 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 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 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%.
Angioplasty.Org Staff, 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".
Angioplasty.Org Staff, 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.
Angioplasty.Org Staff, 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.
Angioplasty.Org Staff, 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")
Angioplasty.Org Staff, 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!!
Angioplasty.Org Staff, 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.
Angioplasty.Org Staff, 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?
Angioplasty.Org Staff, 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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