Restenosis?

[fiona3637]

My husband aged 56 had a heart attack five years ago, LMCA, stented, good result.  Two years agohe had a pulmonary embolus, has been on Warfarin since, PT and PTT checked monthly with varying results and dosage changes.  He recently lost 40 pounds and got his cholesterol down to 140, (It was 399 at it's worst)

Over the last two weeks he has been having chest pain, worse on exertion, radiating to the left shoulder.  He says it is exactly the same as the time he had a heart attack five years ago.  I have been pleading with him to go to the hospital, but he wants to wait until the middle of next week to call his cardiologist, and says he hopes he just needs a new stent, and is worried he will have to have his chest cracked.  (He is an O.R. nurse).....what is the likelihood it is the old stent that has closed off as opposed to his needing a new stent in a different vessel?  Or that he will need a CABG?  When he had his pulmonary embolus two years ago they cathed him and said the stent was clear.....TIA

[Tarheelguy1967]

I don't think restenosis automatically means CABG.  I've had restenosis in my LAD stents twice, and they were able to fix that problem with angio the first time and a new stent underneath the original stents the second time.  But certainly not something that should be put off - if CABG is the only solution, it is sure better than having another MI and a worse outcome.  I'd recommend he get to the cardio as soon as possible and not put this off - he knows his symptoms I imagine and should probably get a nuke stress test or cath based on what his cardiologist wants to do.  Understand your concerns - good luck to you and your husband.  

[Jack54]

I can relate with your husband on the fear of the "big crack", but I would never knowingly put off having a cath when my angina starts and continues to get worse, until I am having to suck on nitro. The last time I did this, I had a 95% blockage in my LAD. Very close to death.

CAD is most often unpredictable I think, but the odds are (MAYBE) that his stent has restenosed. Especially if none of his prior caths have shown any other blockages. New blockages can surely form in 2 years though.

This is just opinion but if he feels like he did when he had his mi, then I think it is the stent that is occluded. I had a blockage one time that caused angina in my back, upon exertion. After a stent, I have never had this type of angina again.

Make him get a cath, or a 64 slice coronary artery ct scan now!

Best of luck and health to your husband,

Jack