Possible failed coronary stent

[kevricky]

3xCABG done some 15 yrs ago.NO heart muscle damage. Totally asymptomatic after surgery for 14 + years.

Last yr. experienced symptoms of some shortness of breath (not necessarily associated with exertion) and lack of energy. Angiogram determined that one graft had failed (internal mammary).

. Had medicated stent placed in Oct last year..

Within two months after stent was placed, symptoms seem to be returning..Some shortness of breath, no energy..NO PAIN AT ALL. If stent has failed, can that stent be replaced with another? If not, what is done?


Thank you.

[CCFHeartMD 12]

Based on what you have described,  I assume that after the drug-eluting stent (DES) was placed 10/2011, your symptoms IMPROVED first, but now it seems they are getting worse again.  This would indicate that your shortness of breath and fatigue are indeed equivalent to "angina".  I would consider repeat the catheterization to make sure the stent is in good condition.  There are some factors which would affect the durability of DESs (in-stent restenosis), such as stent position, under-expansion, and high cholesterol.  Your MD could re-expand the stent, and medications could be maximized to lower lipids.  IF necessary, another stent could indeed be placed inside an old stent.

If there is some doubt as to whether there is another cause for your symptoms, I would consider a stress test to help pin-point areas in your heart that are underserved by blood supply.  If conditions other than coronary blockages are suspected, a metabolic strest test (CPET) could be very useful.  

[kevricky]

Thank you. Good information. I didn't know that "angina" could be without pain.

As I recall, the stent posed no difficulty in placment..no curves, etc. Cholesterol was not a problem HDL/LDL ratio is good. Don't know if stent was fully expanded when placed, but looking at results after placement as doc showed me, seemed fine. Have been on Plavix since placement.  

If stent has failed and is either re-inflated or have placed, would that create a situation where the vessel involved would of necessity be  made physically narrower?

Again, thank you,

[ed34]

Hi, I'm not a Doctor, but I've had 10 stents and a triple bypass, so I have had some experience. Stents, whether medicated or not, can block. The medicated stents have a drug on them which 'HELPS' to inhibit scar tissue forming. However, as you know, the stent is a mesh, meaning only a small percentage of it actually touches the artery wall, around 10-15%. If a stent does block, then another stent can be placed inside, but these too tend to end up blocking. Stents seem to work better in some people than others, and in some arteries better than others (one of the mysteries of the universe). You are jumping the gun a bit here though as you know. It could be that another blockage has formed and yes they can form quickly, it has happened to me. I went from zero to 99% in my circumflex in just 3 months, but I was under intense emotional stress. However, I THINK there may be a better solution, which maybe a Doctor will verify when they read your post.
I had a blockage in my circumflex, for which 2 stents were applied. A Month later my cardiologist called me to have another angiogram, he had looked at the images, and could see another problem which was possibly missed. My Cardiologist was away when I had the procedure, but his registrar did the procedure. He was confused, because the images showed the vessel fully open, not a single problem could be seen. However, he decided to go with the consultants expertise and did an FFR (fractional flow rate) on the vessel. This is a tiny sensor on the catheter tip which gives a readout of pressure/flow rates in the artery. He started at the top, then slowly descended it down the vessel. Halfway down the flow rate halved, yet nothing could be seen. He stented the area where it dropped and then the flow was the same down the complete vessel. It took another 2 stents to achieve this. It is my belief that this was an area where the endothelium was inflamed, but not enough to be visual, and was ready to start forming disease. I'm glad I went in for the procedure because it has probably saved a lot of symptoms. Maybe they could do this to your LIMA vessel, to see if any other areas are likely to cause problems in the near future.
I've never understood why this fantastic tool isn't used as a standard procedure, the naked eye can't see everything going on. It seems to be taken for granted that a stent will cure the symptoms, but there are so many cases where this isn't so.