Restenosis in LDA

[Jon__0]

Posted by Jon on June 24, 1999 at 11:29:33
I am a 50 year old white male that had restenosis following a ballon angioplasty and would appreciate your perspective on my case to determine if my treatment will limit restenosis and any options I have if further restenosis occurs.
When I found I had high cholesterol 10 years ago I went on a low-fat diet and began 30 minutes of aerobic exercise 5 days a week.  My total cholesterol has consistently been in the 240 range with HDL levels around 40.  I have had adverse reactions to all cholesterol medications except Niacin.  My LDL levels could never be controlled and are in the 170 range.  
In April of this year I started having minor chest discomfort while exercising.  During and angiogram an 80% blockage was found in my LAD and a 50% blockage in my RCA.  All other arteries were open.  The 80% blockage was opened with a balloon and 2 stents installed next to each other.  During the procedure the artery went into spasm twice and my heart had to be restarted.  
Following the procedure I was put on 500 mg of Ticlid for 2 weeks and put on 25 mg of Toprol.  This has controlled my blood pressure to about 120/80 with a pulse of 70.  I started cardiac rehad after 2 weeks and had no angina until 7 weeks after the angioplasty.  
I started having minor angina in cardiac rehab and, based on an echo stress test, my cardiologist decided to do another angiogram.  During the angiogram blockages were found at both ends of the stents in the LDA, but not within the stents themselves. He ballooned both blockages and added a third stent at the downstream blockage.  There were no complications with this procedures (e.g. spasms).  
My follow-up with the cardiologist indicated that there is a 40% chance that restenosis will occur within the next 6 months.  He also indicated that if restenosis occurred my options would be limited to another balloon procedure or by-pass surgery.  He also indicated that the blockage could be so low in the LDA that the size of the artery in this area would be too small for effective by-pass surgery.  
I asked him about other procedures to remove the blockage such as laser that I had read about on you web page.  He said that he used to do those procedures, but found the success rate less that balloons and stents and no longer performs those procedures.  He mentioned the research on using radioactive materials, but was not involved with this project.  
This Friday I am starting cardiac rehab 2 weeks following the second procedure am still on the 25 mg of Toprol.  I am also seeing a specialist in cholesterol control who has me on 1500 mg of niacin to control my LPA cholesterol levels.  He has also recommended to minimize restenosis that I eliminate as much stress as possible in the next 3 months and limit the intensity of my cardiac rehab.  
I have the following questions:
1. What caused the rapid restenosis?  Could the artery spasms have contributed?
2. What are the chances for restenosis since I have had this one occurrence?
3. If restenosis occurs what options do I have available and what are there typical success rate?
4. Have the placement of the stents eliminated by-pass surgery as an option?
5. What can I do to limit the possibility of restenosis?
6. Should I have any restrictions in cardiac rehab?

Posted by CCF CARDIO MD - CRC on June 24, 1999 at 13:21:58
1. What caused the rapid restenosis? Could the artery spasms have contributed?
A: No, spasm does not contribute to restenosis.  The mechanism is a combination of recoil and proliferation of the intima (scar tissue).
2. What are the chances for restenosis since I have had this one occurrence?
A: About 30%, the same as the first time.
3. If restenosis occurs what options do I have available and what are there typical success rate?
A: This would depend on multiple things including the location of the lesion.
4. Have the placement of the stents eliminated by-pass surgery as an option?
A: Not necessarily.
5. What can I do to limit the possibility of restenosis?
A: Watch your diet, quit smoking if you smoke, participate in rehab.
6. Should I have any restrictions in cardiac rehab?
A: Follow your doctor's recommendations.
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.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
Posted by Jon on June 25, 1999 at 14:14:01

Can you give me any information on the success rates for procedures for removing the scar tissue such as lasers?  My cardiologist told me that he stopped using these procedures in general because of the low success rate.  Does the Cleveland Clinic Heart Center ever use these procedures to treat restenosis if appropriate for a particular lesion?  

Posted by CCF CARDIO MD - CRC on June 28, 1999 at 16:35:49
We too are not using them very often due to low success rates.
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.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.