Fractured Cardiac Stent- Bare Metal

[Ladye3608]

   While residing in Charlotte, North Carolina, I had a Bare Metal Stent implanted in my Right Coronary Artery on January 31, 2002. The symptoms were shortness of breath and chest pains. A heart cath was performed and the diagnosis was 70% artery blockage. After the implant, my life returned to normal. Exactly one year later, my symptoms returned and the chest pains were more painful. Another heart carth was performed but with results of the the stent being fractured into three pieces. My cardiologist stated that my right coronary artery has a lot of scar tissue and that is the reason for the stent fracturing.  Ever since then, I have been having these same symptoms along with heart attack symptoms. I have been admitted to hospitals, numerous ER visits, and many tests performed but negative results.  My family and I relocated here to Georgia two years ago. The symptoms have gotten worse recently.  Now, my cardiologist states that she is convinced that the stent is not the problem and will not help me find a solution as well. She keeps saying that it could be a GI problem but I am being treated for that with medication and have no symptoms anymore.  My new primary care physician is convinced that the stent is causing these problems and referred me to another cardiologist for a second opinion.  I don't understand what the real problem is when everything else has been ruled out except the stent. How does she know it isn't the stent if she hasn't done another heart cath to rule it out? All of my stress tests have come back negative.  Recently, my PCP ordered an echocardiogram which showed I have another small Ventricular Septal Defect, my heart is thickened, and my EKG showed that I have a Right Bundle Branch Block.  Please help me with my cardiologist's reasoning because she doesn't make any sense to my PCP or me at all.  

[ed34]

You had a second angiogram where it showed the fractured stent. I assume that although it contains fractures, the cardiologist is happy with there being little restriction to blood flow through the stent. It has come to light that perhaps cardiologists need to rethink blockage sizes. At present anything 70% and above is treated with stents or bypass, but anything left is not seen as urgent. It is now apparent that some people feel discomforts with blockages of small sizes. Lots of patients go to hospital with chest pains, yet only small blockages are found on angiograms and other reasons are searched for. In most cases, there are no other reasons so it is assumed that smaller blockages can cause angina.
The cardiologist who mentioned scar tissue was correct, and this is a big problem with bare metal stents. In an ideal situation, you want the artery to grow a nice new smooth lining through the stent. However, scar tissue forms first and this grows quickly and to enough of a degree in many cases to form a serious blockage. This is exactly why the newer drug eluting stents were developed. They have a drug coating which inhibits scar tissue from forming, but allows the new smooth lining to grow.
I would seek a second opinion and tell them you definitely have strong angina symptoms which is ruining your quality of life. They can access a copy of your angiogram if you tell them the hospital before hand, to give them time to get the copy for your meeting.
I think its sometimes possible to put a drug eluting stent inside a bare metal stent, but I'm guessing it wouldn't be wise if it's fractured. I do believe there are special tools and methods to extract stents, they basically have hooks which collapse the stent into a sheath for extraction. Again, probably tricky with fractures but the second opion should cover all these topics. Please let us know what they say and be tough, it's your life. You don't want to spend the rest of it feeling like you do.

[itdood]

Get a second opinion for sure.    One would think that a cath would be in order to make sure the area hasn't occluded again.  A CT scan or MRI might also help to make sure it's not causing problems.  Best of luck.