In-Stent Restenosis Scar Tissue

In November 2009 I had a heart attack and received a Taxus drug-eluting stent.  Within nine months, having failed a treadmill stress test, my cardiologist scheduled another catheterization.  It was discovered that my stent had completely clogged with scar tissue, leaving that part of my heart dead with no remedy.  My RCA was stented with a Promus drug-eluting stent (both stents are manufactured by Boston).  This was in September of this year, 2010.  I am a nervous wreck about whether or not this new stent is clogging, which will kill me if that is what is happening.  My doctor tried to re-certify a nuclear stress test, which my insurance company, Anthem, has denied.  I realize that no test is 100% accurate, but this test could possibly save my life.  My cardiologist is refusing to do a pear to peer phone consult with the insurance company with no explanation to me.  What can I do?  

[kenkeith]

QUOTE: "It was discovered that my stent had completely clogged with scar tissue, leaving that part of my heart dead with no remedy".

>>>>>What test determined you had dead heart cells?  What is your heart's current capacity to fill and pump?  Are you saying your stented occlusion is now completely blocked or just a fear of blocking? What is/has been your symptoms?  If you don't currently have symptoms, the insurance is not going to pay for a test based on the probability there may be restenosis.  

Maybe I don't understand your problem and what you are asking.  

[ChatterAlly]

I have had my stent restented in my RCA and there was never any fear of dying because it clogged.  This is quite common. It's certainly never been any concerm to me.  Why do you think you will die?  What are they basing this on?  I am confused also.  Why worry without any provocation?  Accept the fact that you have heart disease and because of this you need to make lifestyle changes, become active and proactive about this disease.  Don't give into fear.  There is no reason to be afraid. Stress will wreak havoc on your body if you allow it to. Take care, Ally

[BeeCharmer13]

Let me try to make this clear.  In November of 2009 I had a heart attack - a Taxus stent was implanted which, by the time I had (none to few) symptoms and failed a treadmill test at my dr.'s office, was 100% occluded with NO REMEDY.  This part of my heart muscle is dead.   I had a second catheterization this September, a couple of months ago.  Restenosis occurs rapidly, within 3-6 months from my understanding or maybe sooner with me, so I am afraid the new stent will clog the same way the first one did (Taxus and Promus drug-eluting stents).  My lifestyle is changed as much as I can -- I have a very good diet and walk several times a week, and this really won't affect the scar tissue formation.  I am asymptomatic while the stent is having this scar overgrowth, which is a well-known phenomenon, especially in diabetic femailes.  There isn't an option for putting another stent within stent unless you are able to have tests to determine the necessity!

I am 63 years old and have been diabetic for over 30 years.  The arteries tend to narrow in long-time diabetics, which compounds the problem.  I also have high cholesterol, am nearly a vegetarian, and take 80 mg. of simvastatin per day.  It is a bad family history here - diabetes and heart disease are the genetic gifts from my forebears, and my fibromyalgia complicates recognition of pain symptoms from my heart.  I hope I have cleared this up -- I don't know what my heart capacity is right now.    Thank you so much for your response - maybe some pain symptoms would prompt Anthem to cover my doctor's requested nuclear stress test?

[kenkeith]

Sorry, I didn't get back to you.  Yes, angina pectoris pain should get the medical attention you need.  I have a heart condition, and prior to any test the paper work indicates that I have chest pain.  I do have chest pain but it is controlled with medication, and I believe that would be the only way for insurance coverage.  It seems your doctor would offer an appropriate explanation so the insurance would partially cover the costs.

It is true that diabetics often don't have angina even though there is blockage, but from an insurance standpoint that would not be a sufficient reason for the insurance coverage of another test.  I think your doctor (or nurse) may not have adequately offered an explanation on their paper work.  Then at the same time it is not proper to offer false information.  You may want to get a second opinion especially if you begin to have angina.

I haven't ever heard of a doctor calling an insurance company to get approval for giving a test for symptoms expressed when appropriate.  I do know sometimes the insurance will not pay for a procedure when considered unnecessary.  A good doctor would know or should know when and how to effectively treat their patient.

Hope this helps and if you any further questions or comments you are welcome to respond.  take care.