My mum is 50 years old and had a heart attack 2 months ago. One of her arteries was 100% blocked and one other was 50% blocked. She had one medical stent in the 100% blocked one and they said she can come back in 6 weeks later to have the other stent in the 50% (they didn't believe it was too serious). Anyway, a few days later she had chest pain and left arm pain, was rushed into hospital and they decided to do another angioplasty and stent the other main artery (this time they did a blood flow measure and found out that it was actually 80% blocked as oppose to the previously thought 50%). They also put a stent in a smaller artery that was 80% blocked.
A few days later again, she was rushed back into hospital with more pains. They did a trophin level test which came back positive so they did another angioplasty. They found that they had cut one of the main arteries when they did the previous angio. They then stented this. Therefore all in all, she has 4 stents.
After this she was still having pains and was rushed into hospital another 4 times with more pain. They have said its not the heart. They have done a ct angio, nuclear stress test, numerous ECGs, ecco's perfusion test all have come back clear. They said the pain that she is experiencing seems to be costa condrotis (not sure of spelling :)). She has also had 2 treadmill tests- one she did 9 mins and all was clear then we got one another with a different doctor who didn't look at her history. She lasted 10 mins however, her ECG during this test was a slightly unusual. He said you might need to have another angio so we showed the results to the cardiologist who did her stents and he said the fact that she lasted 10 mins with no pain, the ECG is insignificant and he said that it is likely to be slightly unusual due to her having 4 stents and 3 angios. She still gets chest pains/ movement across the left breast towards the left arm- could this be anything else. i.e. restenosis?
They said the pain is Costa condrotis and we have rejected the next angiogram to see how things work out. I was wondering if any of guys could give your opinion on this. My email address is ***@**** if you want to get in contact with me or just post back on here- would really appreciate all of your advice just so we get idea- thank you :)
Well, this requires a bit of history and also depends on the types of stents used. First, going back a few decades, arteries were simply pushed open internally using an inflated balloon. However, in 90% of cases, the arteries collapsed again. Next came a device to hold the artery open once inflated. The STENT. The first ones were bare metal, and just a wire mesh. Wrapped around the balloon, they would be pushed tightly against the artery lining as the balloon was inflated. There became two problems associated with Stents. Firstly was clotting of the blood due to the irregularity of the wall surface, secondly restenosis from scar tissue growing along the artery lining. Clotting and restenosis from scar tissue can happen pretty quickly. Anticoagulants were introduced into the equation to reduce the risk of clots, but restenosis is still a higher risk with bare metal stents which are still used. They are cheaper.
Next came the Drug Eluting Stent (DES). This beauty was coated with chemicals to inhibit scar tissue forming, but had no benefits over clotting. However, if you look at a Stent, at how it's just a mesh with lots of open spaces, the chemicals only touch 1-2% of the artery lining. This means scar tissue can still grow but it did show some benefits compared to bare stents. The latest idea is the Drug Eluting Balloon. When inflated, a balloon will touch over 90% of an artery lining because if conforms itself to the shape. Coated with the same chemicals as the DES, this basically delivers the chemicals to virtually all the artery lining. However, the DEB is only used for vessels that are too small for stenting at the moment. I hope to see this balloon used inside DES stents, and I have no idea why it hasn't been recommended yet. So in answer to your question, yes, restenosis is possible and quick.
On another point, if you imagine an artery with a fair amount of calcification in the Lumen (Area where blood flows through), and imagine a balloon crushing this into the artery wall, you can imagine the trauma given to the vessel. It is thought that this process could also produce pain similar to the Angina the patient initially had. I had a 100% blockage in my left artery, and I insisted they remove as much plaque as possible before stenting. I couldn't bare the thought of all that solid plaque being squashed into the wall. They had some amazing tools to do this, even a safety net to catch large pieces of freed plaque. They had rotary diamond tipped drills, they had lasers and even devices which could snip off plaque and store it inside the cutter. When the artery was clean, before they stented it, I watched it increase in size threefold on the screen and my ECG immediately changed. I was then in the lap of the Gods so to speak, after stenting, to see if restenosis would occur. There is nothing you can do, just hope it doesn't occur.
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