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Stent blockage after 2 months
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Stent blockage after 2 months


  Hi,  Two months ago my mother expericenced burning in her chest,and
  went to the hospital emergency. She was kept in overnight.The following
  day an angiogram was done and a blockage was found. An angioplasty
  was then done and a stent was installed. Everything seemed to go well.
  She was on Ticlid untill a month ago. Last week she went for a stress
  test. a few minutes after the test she had a pain in her chest. She
  was sent to emergency, the pain lasted for 1/2 hour. She was kept
  in the hospital for two days untill another angiogram could be done.
  The angiogram revealed a blockage in the stent. We have been told
  they want to put a smaller stent in the original stent to clear the
  blockage. Our family is concerned that this does not address the reason
  for the blockage. We fear the new stent will become blocked as quickly
  as the first one did.Please advise us what could be done, so we can make
  the proper decision.My mother is age 69, has been in very good health.
  She also had carotid surgery in Jan./98. Thank you very much._______________________________________
_____________Dear John,  Unfortunately "in stent restenosis" can and does happen and is a completely different process than the atherosclerosis that formed the original blockage.  Because in stent restenosis has been so difficult to deal with there have been many studies and thoughts on how to best avoid it's occurance as well as how to best treat it when it does occur.  Examples as such are placing a stent within the stent with or without pretreatment with a rotational device to clean out the stent, at a few investigational centers such as the Cleveland Clinic Foundation there are patients being entered in to a trial where radiotherapy is applied to the in stent to essentially melt the reactive fibrosis.  Of course when all else fails or the options are limited one may have to consider undergoing bypass surgery to relieve the pain and ischemia of the obstruction.
Currently we do not understand why some patient's ateries react so vigorously and others do not, however one can not asssume that the same reaction will occur in the second stent; there is no guarentee that it won't and this is why the patient's participation in the decision making is so important.  If surgery is a possibility(that is to say if your mother could undergo surgery at an acceptable risk) then the patient and physician need to weigh the benefits and risks of another attempt to fix the blockage with catheter base technology(angioplasty,stent,etc.) with that of bypass surgery.  
The fact that your mother has carotid atherosclerosis as well means that most if not all of her arteries have disease in them, and given that atherosclerosis is a progressive disease she should continue to monitor her risk factors with her physician and maximally reduce them as an attempt to halt the progression of the disease which would mean more angioplasties and surgeries; examples of risk factor modification would be stopping smoking, controlling cholesterol and having a daily exercise program.  
Just in case you did not know the Ticlid that your mother took for one month is a medicine that prevents thrombosis(clot formation)in the stent and unfortunately does not address the fibrotic reaction that occurs sometimes.  If you are interested in having your mother seen by one of the interventional cardiologists at the Cleveland Clinic Foundation for consideration of the radiation stent trial(to treat in stent restenosis) just call 1-800-CCF-CARE and ask for an appointment with Dr.Ellis who is head of the catheterization laboratory and that particular trial.  Information provided in the Heart Forum is intended for general informational purposes only, actual diagnosis and treatment can only be made by your physician(s).  





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