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RESTENOSIS, SCAR TISSUE
In November 2009 I had a heart attack, catheterization, and received a Taxus drug-eluting stent. Within nine months, after "failing} a treadmill stress test suggested by my doctor (and my having had few to no symptoms), my cardiologist scheduled another catheterization. It was discovered that my Taxus stent had completely clogged with scar tissue, leaving that part of my heart dead with no remedy. At that time, 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 wondering whether or not this new stent is clogging too, which will probably kill me if that is happening. My doctor's office 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 peer-to-peer phone consult with the insurance company with no explanation to me. He is doing nothing. Is this even ethical? What can I do? I do not know what my heart capacity is at the moment. This test is too expensive for me to afford.
At this point, it seems my only option is to have some sort of symptom in order to have insurance coverage. Does anyone have any better ideas? I had asked this question previously, but apparently I didn't make it clear. I hope this is miore clear. Thank you for your response!!
At this point, it seems my only option is to have some sort of symptom in order to have insurance coverage. Does anyone have any better ideas? I had asked this question previously, but apparently I didn't make it clear. I hope this is miore clear. Thank you for your response!!
My sons bypass was after he had had a heart attack and did not know it. The Doc showed him on the cath that was done.She said it had destroyed part of his heart.He is doing great now. I don't know why they can't check for you. I have several caths done without the stress test. But then they know I have cogestive heart failure. It might make a difference. You are correct about your diet. It has helped a lot. I was told by my Doc that I need a little red meat. I am careful not to over do. It has kept my LDL where I want it.
I don't believe they can tell dead tissue from an angiogram. All they would see is irregular wall movement and this could mean a few things, even stunned tissue which can recover.
I too didn't realise you could rotablate a stent, I wouldn't recommend it anyway. The tool has diamond cutters and would mangle the stent to shreds. The only procedure I know of is to place a second stent inside the first.
Well, what you are basically looking for is ischemia, because this is what a blocked stent would cause. It would produce angina symptoms but can also be detected on a stress echo. I had a stress echo recently which showed my 5 new stents are fine but the bottom of my lad is causing slight ischemia because of 2 known small blockages. I'm sure a stress echo would be less cost than a nuclear scan?
For this test they basically inject you slowly with chemicals to get your heart gradually racing. They constantly monitor your heart rate, blood pressure and Oxygen saturation. When the test is complete your heart very quickly slows back down.
I too didn't realise you could rotablate a stent, I wouldn't recommend it anyway. The tool has diamond cutters and would mangle the stent to shreds. The only procedure I know of is to place a second stent inside the first.
Well, what you are basically looking for is ischemia, because this is what a blocked stent would cause. It would produce angina symptoms but can also be detected on a stress echo. I had a stress echo recently which showed my 5 new stents are fine but the bottom of my lad is causing slight ischemia because of 2 known small blockages. I'm sure a stress echo would be less cost than a nuclear scan?
For this test they basically inject you slowly with chemicals to get your heart gradually racing. They constantly monitor your heart rate, blood pressure and Oxygen saturation. When the test is complete your heart very quickly slows back down.
They probably elected not to do a by-pass due to all my other health complications - diabetes, hyperthyroidism with multi-nodular goiter, high blood pressure, etc. They just installed the second stent after the second cath, hence there has been no test on the second stent to see if it is clogging -- that is the point of my concern. The only way they would do another catheterization would be if a stress test or my heart symptoms prompted it --THEN they could see if it is clogging. That's what I want -- by now there probably would be evidence if the scar tissue is coming back.
I wasn't aware that they could "roto-root" a partially-blocked stent (atherectomy?) - I wondered about that initially, but didn't ask about it since their opinion seemed to final about the 100$ blockage and dead heart muscle.
I am practially a vegetarian, and never eat red meat unless it is super-super-lean and then very infrequently. I am practically a vegetarian except for occasional fish and chicken; I am convinced this diet has prevented any kidney problems after 30 years of diabetes. I think my heart disease would have been further along without my diet.
The diagnosis that the heart muscle is dead was what was given at the time of the second catheterization & new stent. (The first blocked stent is in my LAD) I am not sure how they determined that the tissue is dead - can't they tell with the catheterization? I am still in a quandary on how to prompt Anthem to pay for a stress test....
Thank you both for your responses to my question!
I wasn't aware that they could "roto-root" a partially-blocked stent (atherectomy?) - I wondered about that initially, but didn't ask about it since their opinion seemed to final about the 100$ blockage and dead heart muscle.
I am practially a vegetarian, and never eat red meat unless it is super-super-lean and then very infrequently. I am practically a vegetarian except for occasional fish and chicken; I am convinced this diet has prevented any kidney problems after 30 years of diabetes. I think my heart disease would have been further along without my diet.
The diagnosis that the heart muscle is dead was what was given at the time of the second catheterization & new stent. (The first blocked stent is in my LAD) I am not sure how they determined that the tissue is dead - can't they tell with the catheterization? I am still in a quandary on how to prompt Anthem to pay for a stress test....
Thank you both for your responses to my question!
" I am surprised with much damage that he did not do bypass"
If a vessel is totally blocked, then the tissue losing the feed will die. Re-establishing a flow of blood to that tissue will not restore it back to health. However, I am curious as to how they have established tissue death.
In 2007, I had a few attacks of MI and they stented the offending vessel. During the angioplasty they noticed my Left anterior descending had a long total blockage at the top. It was assumed then that a lot of tissue would be dead, so they left the blockage in place. A nuclear scan revealed the tissue was receiving blood from another route.
If a vessel is totally blocked, then the tissue losing the feed will die. Re-establishing a flow of blood to that tissue will not restore it back to health. However, I am curious as to how they have established tissue death.
In 2007, I had a few attacks of MI and they stented the offending vessel. During the angioplasty they noticed my Left anterior descending had a long total blockage at the top. It was assumed then that a lot of tissue would be dead, so they left the blockage in place. A nuclear scan revealed the tissue was receiving blood from another route.
You are probably not having any problems he can explain to the insurance company. I am surprised with much damage that he did not do bypass. That is what they did for my son. I had a blockage in 1989 and they did an atherectomy(they went in with a 'rotorotter' and removed the blockage ) I have been checked several times and now every 3 years. My blockage is only up to 40% . If I have it done again I will not have a stint put in. My doctor has been told. He will have to remove it. They still do that in Georgia.I also cut way back on red meat and that has helped keep it clear.
You say that the area of heart tissue is dead with no remedy? How did they conclude this?
For many years this was a made assumption but it was found that many patients develop collateral vessels which feed into the area. Not all cases develop these vessels, and not all cases develop sufficient flow for exertion, but certainly to sustain tissue life. Some collateral vessels are too small to be seen on a standard angiogram and the only real way to tell is a nuclear scan, which will detect the presence of oxygenated blood. Even an echo is not ideal, if a full blockage is known to exist and the heart muscle isn't moving properly, they sometimes simply term it as dead and scarred, but it can simply be alive with low oxygen.
Which vessel was the first stent placed? if you have low to no symptoms, then it sounds like blood could be getting to the tissue somehow.
With regards to your other stent, in the most recent angiogram, they should have noticed if this stent was also narrowing.
For many years this was a made assumption but it was found that many patients develop collateral vessels which feed into the area. Not all cases develop these vessels, and not all cases develop sufficient flow for exertion, but certainly to sustain tissue life. Some collateral vessels are too small to be seen on a standard angiogram and the only real way to tell is a nuclear scan, which will detect the presence of oxygenated blood. Even an echo is not ideal, if a full blockage is known to exist and the heart muscle isn't moving properly, they sometimes simply term it as dead and scarred, but it can simply be alive with low oxygen.
Which vessel was the first stent placed? if you have low to no symptoms, then it sounds like blood could be getting to the tissue somehow.
With regards to your other stent, in the most recent angiogram, they should have noticed if this stent was also narrowing.
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