After PTCA--Outcomes?

  Last week I had a successful PTCA w/stent procedure on a 20 mm lesion located in my LAD.  I am now on Plavix and aspirin therapy.  In view of my profile (age (50), no MI history, excellent LV function and EF>60%), my doctor said my prognosis is very favorable.  I'll be seeing him next week for a follow-up visist.
  In discussions and reading, I understand the risks of abrupt closure and acute stent thrombosis fall off after the first week...which is about now.  Could you confirm this, and also tell me, from your experience, what other complications may arise over the next 3-4 weeks, and what the frequency is?
  Also, I understand that the need to perform another PTCA on the lesion due to restenosis is about 10-15% by 6 months.  When and how would restenosis be noticeable to me?  What tests could my cardiologist run to determine if restenosis is happening? Finally, is there anything I should be doing or taking, medication or supplement, to help myself and reduce the risk of complication?
  Thanks in advance for your assistance and thoughtful insights.

[CCF Cardio MD - MTR]

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Dear Rich, thank you for your question.  With an angioplasty/stent procedure that has no in-hospital complications, the risk of subacute stent thrombosis over 1-2 weeks after the procedure is < 1% with aspirin and plavix therapy.  After 2 weeks, the stent begins to endothelialize which means that cells coat the inside lining of the stent eliminating the risk of thrombosis.  Restenosis within a stent is caused by proliferation of the intimal cells which line the inside wall of the artery.  This process occurs in approximately 15% of patients and is usually identified by a recurrence of angina or the presence of ischemia on a stress test.  Routine stress tests after a stent procedure are not recommended but many cardiologists prefer to perform such a test 3-6 months after the procedure to ensure that restenosis hasn't occurred.  Many different therapies have been tested to prevent restensosis, but there are no medications that you could take that have been shown to be effective.  However, to prevent the progression of atherosclerosis in areas other than the stented segment, you should exercise daily, eat a low-fat and low-cholesterol diet, and avoid tobacco.  

I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.  Good luck.
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