Stent Restenosis---Advice desperately needed!



J

John Decker

Guest
Hello Everyone...

I need some advice about my medical condition. I am 60 years old and otherwise in good health with
the exception of one clogged heart artery. Cardiologist have told me that the rest of my heart &
arteries are fine. The Cardiologist placed a stent in that single defective heart artery. After
three months restenosis occured and the Drs. performed angioplasty again and this time irradiated
the restenosis tissue with beta particles.

Three months later I am experiencing symptoms of restenosis again and went to the Cardiologist
again, explaining my symptoms. The Drs. will do a heart catheterization next week to find out for
sure. I am gradually beginning to realize that stents for some people are not perfect and reasonable
expectation for success without restenosis is in the distant future. I am so depressed and angry
with this procedure.

The Cardiologist have suggested three possible alternatives for the restenosis and seemly want me to
make one of the following decisions.

1. Angioplasty and nothing else. This did not work before; so I am not sure that it is a
proper option.

2. Angioplasty and insertion of a medicated stent within the first stent. I do not like the idea
of a stent within a stent. This I think would narrow the lumen of the artery and perhaps
cause restenosis again. The medicated stent is also another problem that I am conserned with.
I have read reports about the medication on some type of stents causing blood clots and death
of patients.

3. Single artery bypass surgery. Since the rest of my arteries and heart are fine, I have
reservations about doing this type of procedure and there is always a comparatively significant
chance of death with open heart surgery.

My question: What would be the odds of preventing restenosis by doing the angioplasty again and re-
irradiate the tissue again with beta particles. This would be the same procedure that was done the
second time that I have described above. I realize that this procedure did not work before but
perhaps a second treatment of radiation might stop the scar tissue from occluding the one bad heart
artery that I have?

Any advice is welcome! I hope and pray that I make the right decision.

John Decker
 
"John Decker" <[email protected]> wrote in message
news:[email protected]...
> Hello Everyone...
>
> I need some advice about my medical condition. I am 60 years old and
otherwise
> in good health with the exception of one clogged heart artery. Cardiologist
have
> told me that the rest of my heart & arteries are fine. The Cardiologist
placed a
> stent in that single defective heart artery. After three months restenosis occured and the Drs.
> performed angioplasty again and this time irradiated
the
> restenosis tissue with beta particles.
>
> Three months later I am experiencing symptoms of restenosis again and went
to
> the Cardiologist again, explaining my symptoms. The Drs. will do a heart catheterization next week
> to find out for sure. I am gradually beginning to realize that stents for some people are not
> perfect and reasonable
expectation
> for success without restenosis is in the distant future. I am so depressed
and
> angry with this procedure.
>
> The Cardiologist have suggested three possible alternatives for the
restenosis
> and seemly want me to make one of the following decisions.
>
> 1. Angioplasty and nothing else. This did not work before; so I am not sure
that
> it is a proper option.
>
> 2. Angioplasty and insertion of a medicated stent within the first stent. I
do
> not like the idea of a stent within a stent. This I think would narrow the
lumen
> of the artery and perhaps cause restenosis again. The medicated stent is
also
> another problem that I am conserned with. I have read reports about the medication on some type of
> stents causing blood clots and death of patients.
>
> 3. Single artery bypass surgery. Since the rest of my arteries and heart are fine, I have
> reservations about doing this type of procedure and there is
always
> a comparatively significant chance of death with open heart surgery.
>
> My question: What would be the odds of preventing restenosis by doing the angioplasty again and
> re-irradiate the tissue again with beta particles. This would be the same procedure that was done
> the second time
that
> I have described above. I realize that this procedure did not work before
but
> perhaps a second treatment of radiation might stop the scar tissue from occluding the one bad
> heart artery that I have?
>
> Any advice is welcome! I hope and pray that I make the right decision.
>
>
> John Decker
>

Hi John,

Unfortunately, it is a bet - you can get some sense of the odds but you can not know for sure in
advance what is best. I went through 2 episodes of restenosis before the third one took - this was
in the pre-stent days.

I think I recall (and someone correct me on this if I'm wrong) that your odds of restenosis do
not change with the number of procedures. So the fact that this happened before should not
discourage you.

I heard a talk by one of the Drs. studying drug eluting stents vs. irradiation and he said the drug
eluting stents were clearly superior in preventing restenosis - except at the edge of the stent
where there is less of the drug. However, I'm sure he was not studying a stent within a stent and I
do not know if there are any statistics on that.

Another thing you might want to discuss with your Dr. is how likely it is that you have built up
good collaterals. These are small vessels that grow from other arteries that supply areas of the
heart normally served by the blocked artery. They act as sort of an insurance policy.

Stents within a stent are not that uncommon and if it were me that is probably what I would go with
- particularly since you are going to be in the Cath. lab anyway. However, I don't feel comfortable
advising you on what is best for you.

Bill - not a Dr.
 
John Decker wrote:
>
> Hello Everyone...
>
> I need some advice about my medical condition. I am 60 years old and otherwise in good health with
> the exception of one clogged heart artery. Cardiologist have told me that the rest of my heart &
> arteries are fine. The Cardiologist placed a stent in that single defective heart artery. After
> three months restenosis occured and the Drs. performed angioplasty again and this time irradiated
> the restenosis tissue with beta particles.
>
> Three months later I am experiencing symptoms of restenosis again and went to the Cardiologist
> again, explaining my symptoms. The Drs. will do a heart catheterization next week to find out for
> sure. I am gradually beginning to realize that stents for some people are not perfect and
> reasonable expectation for success without restenosis is in the distant future. I am so depressed
> and angry with this procedure.
>
> The Cardiologist have suggested three possible alternatives for the restenosis and seemly want me
> to make one of the following decisions.
>
> 1. Angioplasty and nothing else. This did not work before; so I am not sure that it is a proper
> option.
>
> 2. Angioplasty and insertion of a medicated stent within the first stent. I do not like the idea
> of a stent within a stent. This I think would narrow the lumen of the artery and perhaps cause
> restenosis again. The medicated stent is also another problem that I am conserned with. I have
> read reports about the medication on some type of stents causing blood clots and death of
> patients.
>
> 3. Single artery bypass surgery. Since the rest of my arteries and heart are fine, I have
> reservations about doing this type of procedure and there is always a comparatively significant
> chance of death with open heart surgery.
>
> My question: What would be the odds of preventing restenosis by doing the angioplasty again and
> re-irradiate the tissue again with beta particles. This would be the same procedure that was done
> the second time that I have described above. I realize that this procedure did not work before but
> perhaps a second treatment of radiation might stop the scar tissue from occluding the one bad
> heart artery that I have?
>
> Any advice is welcome! I hope and pray that I make the right decision.
>
> John Decker

A fourth option that should be considered after discussing with your doctor(s) is external
counterpulsation (ECP).

Servant to the humblest person in the universe,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

**
Who is the humblest person in the universe?
http://makeashorterlink.com/?W1F522557

What is all this about?
http://makeashorterlink.com/?A26B16397

Is this spam?
http://makeashorterlink.com/?N69721867
 
Studies I have seen indicate that stents and bypasses,in general, do not help you live any longer
but do improve the situation in the event of shortness of breath and pain. In November 2003, I
discovered I have two totally blocked coronary arteries and have refused stents or coronary bypass.
I decided for the time being to treat treat my disease medically. I have other problems so an
immediate 100% efficient heart is like putting a V8 Engine into an old Volkswagon. A gradual
improvement is great for me. My wife tells me I look 10 years younger since I went on heart meds.
ACE Inhibitor, Beta Blocker, Aspirin, Statin, and Niacin.

Do nothing may yet be another choice. From my viewpoint one blocked artery is not too bad. Maybe
you need a second opinion from a Cardiologist who believes in medical care and physical
conditioning rather that a heart surgeon. You know the old saying. If you go to a Barber Shop, you
will get your hair cut!

"John Decker" <[email protected]> wrote in message news:[email protected]...
> Hello Everyone...
>
> I need some advice about my medical condition. I am 60 years old and
otherwise
> in good health with the exception of one clogged heart artery.
Cardiologist have
> told me that the rest of my heart & arteries are fine. The Cardiologist
placed a
> stent in that single defective heart artery. After three months
restenosis
> occured and the Drs. performed angioplasty again and this time irradiated
the
> restenosis tissue with beta particles.
>
> Three months later I am experiencing symptoms of restenosis again and went
to
> the Cardiologist again, explaining my symptoms. The Drs. will do a heart catheterization next week
> to find out for sure. I am gradually beginning
to
> realize that stents for some people are not perfect and reasonable
expectation
> for success without restenosis is in the distant future. I am so depressed
and
> angry with this procedure.
>
> The Cardiologist have suggested three possible alternatives for the
restenosis
> and seemly want me to make one of the following decisions.
>
> 1. Angioplasty and nothing else. This did not work before; so I am not
sure that
> it is a proper option.
>
> 2. Angioplasty and insertion of a medicated stent within the first stent.
I do
> not like the idea of a stent within a stent. This I think would narrow the
lumen
> of the artery and perhaps cause restenosis again. The medicated stent is
also
> another problem that I am conserned with. I have read reports about the medication on some type of
> stents causing blood clots and death of
patients.
>
> 3. Single artery bypass surgery. Since the rest of my arteries and heart
are
> fine, I have reservations about doing this type of procedure and there is
always
> a comparatively significant chance of death with open heart surgery.
>
> My question: What would be the odds of preventing restenosis by doing the angioplasty again and
> re-irradiate the tissue again with beta particles. This would be the same procedure that was done
> the second time
that
> I have described above. I realize that this procedure did not work before
but
> perhaps a second treatment of radiation might stop the scar tissue from occluding the one bad
> heart artery that I have?
>
> Any advice is welcome! I hope and pray that I make the right decision.
>
>
> John Decker
 
Nashville Pete wrote:

> Studies I have seen indicate that stents and bypasses,in general, do not help you live any longer
> but do improve the situation in the event of shortness of breath and pain. In November 2003, I
> discovered I have two totally blocked coronary arteries and have refused stents or coronary
> bypass. I decided for the time being to treat treat my disease medically. I have other problems so
> an immediate 100% efficient heart is like putting a V8 Engine into an old Volkswagon. A gradual
> improvement is great for me. My wife tells me I look 10 years younger since I went on heart meds.
> ACE Inhibitor, Beta Blocker, Aspirin, Statin, and Niacin.
>
> Do nothing may yet be another choice.

What you and your doctor(s) are doing is not "nothing."

> From my viewpoint one blocked artery is not too bad. Maybe you need a second opinion from a
> Cardiologist who believes in medical care and physical conditioning rather that a heart surgeon.
> You know the old saying. If you go to a Barber Shop, you will get your hair cut!

The discerning question here is:

Why go to a Barber Shop if you do not want a hair cut?

Servant to the humblest person in the universe,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

**
Who is the humblest person in the universe?
http://makeashorterlink.com/?W1F522557

What is all this about?
http://makeashorterlink.com/?A26B16397

Is this spam?
http://makeashorterlink.com/?N69721867
 
>Subject: Re: Stent Restenosis---Advice desperately needed!
>From: "Nashville Pete" [email protected]
>Date: 3/5/2004 5:21 AM Pacific Standard Time
>Message-id: <[email protected]>

>From my viewpoint one blocked artery is not too bad. Maybe you need a

"not too bad?"....what if the totally blocked artery is the LAD???

wonder why they call it the "widow maker".....

I agree that the stent and restenting is an issue...my h.o. would be that putting a stent within a
stent may well increase the chances of restenosis...as the lumen would be narrowed even more.....

single vessel bypass?? again..which vessel and where is the occlusion..

good luck

hawki.....
 
I now have 5 stents. each new stent has had a restenosis problem. Stent number one in the LAD
restenosed. During the angioplasty to reopen it some damage was done to the artery just adjacent to
it so another stent was added adjacent to stent number one to cover the damage. Stents one and two
restenosed. This was fixed with the brachytherapy prodedure similar to the one that you had.

Then I required a stent (number 3) in the circumflex artery. That was fixed with a angioplasty with
a "cutting balloon". At the time that was done another stent - this time one of the new drug coated
sirolimus stents (number
4) was put in my LAD upstream from stents one and two. This stent also restenosed. It was fixed by
the deployment of another sirolimus stent (number
5) inside of it. I had another angiogram at three months from the insertion of stent number 5 which
showed I am still free of restenosis.

It is all very frustrating. My understanding is that the correction of restenosius via angioplasty
is about 50 50. The cardiologist told me that the use of the "cutting baloon" improved the
percentages "some". I was also told that using a coated stent within a stent has not been done
enough to generate meaningful statistics.

I had significant chest radiation due to Hodgkin's disease over 10 years ago which may be causing
my artery problems. no one knows if this may also increase the risk of restenosis. With all of
this I carry on a mostly asymptomatic, active life style (I have been skiing twice in the past
couple of months)

Good luck
 
Dr. Andrew B. Chung, MD/PhD wrote:

> The discerning question here is:
>
> Why go to a Barber Shop if you do not want a hair cut?

Because if the only tool you know how to use is a hammer, everything will look like a nail.

Bob
 
John Decker <[email protected]> wrote:

> Any advice is welcome!

Did they use IVUS before doing the radiation ? Intra Vascular Ultra Sound brings a lot of
information and helps tremendously to understand why the restenosis occurs. It finds out in a number
of cases that the stent was under-deployed, increasing the chances for restenosis.

I would definitively make sure an IVUS is done before anything else if you choose to go back to
the cath-lab.

Patrick
 
It seems to me I heard somewhere that John Decker wrote in article
<[email protected]>:

>I need some advice about my medical condition. I am 60 years old and otherwise in good health with
>the exception of one clogged heart artery. Cardiologist have told me that the rest of my heart &
>arteries are fine. The Cardiologist placed a stent in that single defective heart artery. After
>three months restenosis occured and the Drs. performed angioplasty again and this time irradiated
>the restenosis tissue with beta particles.

>Three months later I am experiencing symptoms of restenosis again and went to the Cardiologist
>again, explaining my symptoms. The Drs. will do a heart catheterization next week to find out for
>sure. I am gradually beginning to realize that stents for some people are not perfect and
>reasonable expectation for success without restenosis is in the distant future. I am so depressed
>and angry with this procedure.

[...]

>My question: What would be the odds of preventing restenosis by doing the angioplasty again and re-
>irradiate the tissue again with beta particles. This would be the same procedure that was done the
>second time that I have described above. I realize that this procedure did not work before but
>perhaps a second treatment of radiation might stop the scar tissue from occluding the one bad heart
>artery that I have?

>Any advice is welcome! I hope and pray that I make the right decision.

Just as a general observation, my cardiologist had to do two separate angioplasty-stentings, and
warned me that with each repeat of the procedure the odds of failure increase, so much so that often
bypass becomes preferable to yet another angioplasty or stent. I'm fortunate in that I've been
symptom free for six years now*. FWIW, I was 69 when I had the two procedures.

* The attack was three weeks to the day after the Los Angeles Marathon which I finished without
pain but with so little strength I had to walk much of the distance. The next marathon is this
Sunday, so my anniversary is near. :)

Since the doctor told me that, treatment regimens have changed somewhat (improved, I would hope),
including radiation and medicated stents. Nevertheless I have no reason to think that the general
trend has changed. I'd suggest a very serious discussion with your doctor and ask how he assesses
your options--and get a second opinion if you aren't comfortable with his recommendation..
--
Don [email protected]
 
In article <[email protected]>, Markthree says...
>
>I now have 5 stents. each new stent has had a restenosis problem. Stent number one in the LAD restenosed. During the angioplasty to reopen it some damage was done to the artery just adjacent to it so another stent was added adjacent to stent number one to cover the damage. Stents one and two restenosed. This was fixed with the brachytherapy prodedure similar to the one that you had.
>
>Then I required a stent (number 3) in the circumflex artery. That was fixed with a angioplasty with a "cutting balloon". At the time that was done another stent - this time one of the new drug coated sirolimus stents (number
>4) was put in my LAD upstream from stents one and two. This stent also restenosed. It was fixed by the deployment of another sirolimus stent (number
>5) inside of it. I had another angiogram at three months from the insertion of stent number 5 which showed I am still free of restenosis.
>
>It is all very frustrating. My understanding is that the correction of restenosius via angioplasty is about 50 50. The cardiologist told me that the use of the "cutting baloon" improved the percentages "some". I was also told that using a coated stent within a stent has not been done enough to generate meaningful statistics.
>
>I had significant chest radiation due to Hodgkin's disease over 10 years ago which may be causing my artery problems. no one knows if this may also increase the risk of restenosis. With all of this I carry on a mostly asymptomatic, active life style (I have been skiing twice in the past couple of months)
>
>Good luck
-----------------------------------------------------------
Thanks for the information. I am curious as to how long it was before restenosis occured after each stent was implanted?

John Decker
 
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