Prognosis after stent failure

[pyrovixen3]

Dear Doctor,

In 2001, at age 42, I was diganosed with congenital stenosis of the left main coronary artery just beyond the bifurcation off the aorta, 80% occluded.   A double bypass was performed, and  I was pain free for about two years.  When my symptoms returned, it was determined that scar tissue within the chest cavity was kinking he LIMA graft.  A stent was inserted in an attempt to straighten the kink and improve perfusion.  Over the next few of years, the LIMA was stented several more times (I lost count) because scar tissue formed inside the LIMA at the stent site each time.   Finally, in January of 2006, the decision was made to stent the LMCA.  By June 2006, this too had begun to occlude due to scar tissue, and a second stent was placed in the LMCA with a small portion of it extending into the aorta.  At that time, my docs felt another bypass would be too risky for a number of reasons and would likely fail eventually due to scar tissue if I survived the surgery.  Now I am having persistent cp again, radiating into my left arm, at rest or with the slightest exertion - my typical cp pattern.  SL Ntg is somewhat helpful.  Otherwise, my heart is very healthy.  Repeated angiography and Adenosine stress tests have revealed no other narrowed vessels nor any myocardial damage.  I have no dysrhythmias,  normal bp, normal cholesterol levels.   My only cardiac meds are plavix and ASA.  

Here are my questions:

1)   Is there any link between repeated scar tissue formation at the stent sites to the problems that have recently come to light about self-eluting stents?

2)  If my stent is closing again,  what treatment options do I have other than another CABG?

3) What is my prognosis in this situation?  I am under the impression that total restenosis, woulld result in death.  If so, how long do I have?

[Momto3]

Hello

I can't really offer any answers, but it might help to post your questions as a new question.  That way, more people are likely to see it, and hopefully, some folks can help you out.

Connie

[FredN]

Hi,
I had one incident of chest pain about 3 months ago, while running on the beach. I had cold sweat and headache. It was first time ever felt like that. I am 5'4", 148 lbs, Asian male. I am not over weight at all, just about right.

I am a 43 year old. My chloresterol level was 250 mg/mL before taking lipitor. After taking lipitor for about 2 months, and had a blood test done about 2 wks ago. My Choloresterol is now 129 mg/mL.

Saw a couple of cardiologist. They told me my EKG looked abnormal. Had an exercise test and thallium scan. The doc told me my heart looked like has ischemia, although there is no noticeable scar on the heart.

The doc told to go to the hospital and have an angiogram done. I have nothing against that... however, if he determines that a stent may be needed during the agiogram. That's where I have trouble deciding....

I am thinking, my chloresterol level is down. Only had 1 incident of chest pain, and have never had such repeat chest pain since taking Lipitor coupled with healthy foods and good dose of daily walking and running. I am thinking not to go stenting just yet. If the chestpain repeats like the incident at the beach, then I would definitely go for stenting.

My questions are:

1. What's the likelihood of my having chest pain again?

2. What is the long term effect of stent just outside the heart? Would the movement of the heart cause scar and prolonged inflamation of the area around the stent?

3. Would continued Lipitor, regular vigorous exercises, and reduced chloresterol level of around 130 mg/mL reduce the vessel blockage?

My thinking is if, I no longer have chest pain, and continue to monitor my chloresterol and my heart, I would not have to resort to stenting.

Helpful and accurate assessment of my thinking would be appreciated.

Thanks!

Fred

[ConcernedCitizen123321]

Don't think so negative !!!. God is with you !!!. Check out chelation therapy, I know a number of people who've had it and now have a squeaky clean circulatory system.

[Cleveland Clinic]

1.  That's probably what we would have done as well.  I wouldn't worry about the fact that the stent is out in the aorta.

2.  Have you considered LSU.  There are also good cardiology clinics in Texas, such as Texas Heart in Dallas or Baylor in Houston.  

[pyrovixen3]

More questions:

1.  I was not pleased with the idea of extending the stent into the aorta as was done the last time.  Given my propensity for scar tissue formation, I felt there was a strong chance doing so would introduce scar tissue into the aorta and cause me even more problems.  However, since scar tissue from the previous stent in the LM had formed in the space between the end of the splint and the aortic opening, my docs felt the only way to keep the LM open was to extend the stent into the aorta.  What are your thoughts on this?  

2.  I am currently being treated by doctors at Oschner Clinic Foundation Hospital in New Orleans.  This is one of the most experienced heart treatment centers in the country, at least to my understanding.  Can you recommend another that is relatively close to Louisiana?

[Cleveland Clinic]

1.  The drug eluting stent are supposed to decrease the amount of scar tissue formation in the stent.  In most patients that is the case, however, there are some who continue to form scar.  We think that there is some genetic predisposition to this.  It is very difficult to predict.  An analogy that may be familiar to you is how some people when they cut their skin heal well versus others who form lots of scarring and keloids.

2.  The narrowing stent in the LM is a problem.  Restenting it is the only non-surgical option at this point and we know that it is most certainly going to restenose again.  Given that your heart function is normal and assuming that you are a functioning individual with not serious comorbid conditions, I think you would be an excellnet candidate for repeat surgery.  Try getting a second opinion, maybe from a more experienced medical center.  

3.  Left main restenosis may lead to serious complications including a massive heart attack and even death.  Again, I would get a second opinion regarding reoperation before making any moves at this point.  It is hard to predict how long you have before having a heart attack but the fact that you already have symptoms implies that the stenosis is becoming more severe.  Depending on your coronary anatomy total stenosis may not always result in death although in most patients, unfortunately, the likelihood is high.