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Stents and future prognosis,
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Stents and future prognosis,


Its been nine months since I had  one Stent inserted in my LAD after MI. I was told that the first six months are tricky since complications tend to occur like re-stenosis etc.I think I am past that but there is a question that pops up often in my mind and that is what is the future of the stent:-

1. Assuming I limit the  risk factors can stents last a lifetime, that is could I live to my expected average lifespan without needing CABG etc?

2. How long have stents been used and is there a body of patients who have had stents for decades and what is their present condition?

3. Is it possible to see ( by medication or diet ) regression in atherosclerosis?

4. Out of curiosity how long would that plaque that ruptured and gave a me MI been building up?

I realise that in real life there is a complex matrix at play and that nobody can for sure say what the future is but I am wondering is there certain period that you would expect the stents to fail? In other words do they have a "sell by date"?

And please feel free to fire what ever you think, I won't sue anybody for giving me wrong advice :)

Thanks.
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14 Comments Post a Comment
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63984_tn?1385441539
Interesting questions.  

Starting backwards, (#4)  I would believe that the plaque has been building up for almost a lifetime in the arteries.  Inflamation (inflammation) of the arteries could be the reason for the rupture, and that is why the health professionals want us to adopt behaviors that minimize inflammation, including low fat diets, stress reduction, diabetes control, no smoking, etc.

(#3) When I was in a particularly aggressive CAD period, I doubted my Cardiologist's suggestion that CAD could be controlled, but with nothing to lose after eight stents, I lost the weight, took the suggested drugs, exercised daily.  That was in 2006.  I haven't had an MI or a stent since then.  Two days ago, my ldl cholesterol level was 78 and my hdl was 66.  In 2006,  my ldl level was 201 and my hdl was 29. I don't know what the body of evidence shows, but in my case, I believe CAD can be controlled.

(2) I think stents started being inserted commonly in the mid 1880's, I had my first one in 1999 when I had my first MI.

(1) I've lost 50 pounds, no longer in the Obese catagory.  My diabetes is controlled by a a tight diet, and exercise daily.  I'll turn 70 years old this year and have gone eleven years with heart disease.  A pacemaker also really helped me.  Where I volunteer at a Cardiac Hospital wing, I tell patients and their loved ones that we are fortunate to have heart troubles compared to those with liver, lung and other organ issues, we can through healthy living choices and good drugs and procedures recover.

In my opinion, your stent will be just fine but you have to help it out by living a heart healthy lifestyle.
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1542723_tn?1294451038

Thank you for the reply, I am 47 years old and your case gives hope to people like me. Have happy New Year.
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Avatar_m_tn
To my knowledge the first human coronary stent was implanted in 1986 in France.

The fact that the stent will last all your life does not implies that you do not need a CABG in the future. Other points in your coronaries might be blocked and need it.

I have read some articles that indicates reduction in atherosclerosis plaque with LDL below 70. But there is controversy on this.

As per the evolution of CAD, I do not think that cholesterol is the only (if at all) valid parameter... inflamation (inflammation), Homocisteine, levels of NO (Nitric Oxide), thickness of the intima endothelium layer are all indications of CAD.

Jesus
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367994_tn?1304957193
QUOTE: Assuming I limit the  risk factors can stents last a lifetime, that is could I live to my expected average lifespan without needing CABG etc?

>>>>There is a 20 to 30% chance of a stent having some blockage return in the first 6 months, and there are treating doctors that expand the vulnerable period up to 12 months with drug eluding stents and treat with plavix and aspirin.  Once you are out of this period the outlook for long term patency is quite good.

If the underlying cause that developed your occlusion, there may never be a need for any other therapy.  An assumption is the underlying cause for your CAD is caused by improper diet, life style, etc., and with medication and lowering the generally accepted risk factors may be effective for most individuals, but it seems there is an X factor for some individuals and probably genetic, unable to manage blood pressure, diabetics. etc.

QUOTE: I have read some articles that indicates reduction in atherosclerosis plaque with LDL below 70. But there is controversy on this

>>>>There are different professional opinions on the subject indicating the jury is still out on this condition.   I don't have any personal experience with the issue as my cholesterol is within the normal range dispite having CAD.  It is possible my CAD developed years ago when I didn't do anything to maintain a healthy medical system.  

QUOTE: . Out of curiosity how long would that plaque that ruptured and gave a me MI been building up?

>>>> Reading posts from many individuals seems that plaque can start being a problem with some individuals at an earlier age than generally thought. Some young mitlitary casualties who have an autopsy show signs of advanced CAD.  Then there is a risk for individuals over 40 with family history, diabetics, etc., improper diet, unhealthty life style, etc.  Older >60 indivduals in the US almost all have some CAD.

Thanks for the E-mail and other responders (flycaster and jrbon) have made well-stated comments that you recognize as appropriate, and we can all agree there needs to be more research, etc.

Thanks for your questions.  Take care and we wish you well going forward into the New Year.
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976897_tn?1379171202
"last a lifetime, that is could I live to my expected average lifespan without needing CABG etc?"

It almost comes across that you believe a CABG is the big solution which would last much longer and that Stents are a kind of interim fix until that time arrives, if at all. CABG can fail just as much as stents, in fact I have met patients who have suffered them fail within a matter of weeks. This made me feel lucky to have mine last three months. There is still a lot to learn about why some patients just don't seem to tolerate grafts very well. I do believe a trials using a synthetic artery are taking place, or soon will be, and this is a material which will not block because it's not prone to inflamation (inflammation) or damage. I believe this will be the time when CABG will come into its own. In rehab I met patients who received stents 10 years prior, which are still wide open. However, as stated, blockages can form elsewhere.
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Avatar_n_tn
Hi, I've read loads since my dad passed away suddenly with heart disease last year.  His was silent, so no one knew he was ill.

What i've read is that keeping LDL below 70 is import in preventing progression of the disease and in some cases leads to regression - who knows if it's all true but certaintly worth giving it a look and i can't believe a lot of the healthy practices designed to achieve tis would do any harm anyway.

i was particularly interested in www.heartattackproof.com  if that link doesn't take you there google Dr Esselstyn.  However i don't know that he has all the answers.  I think it's also important to read up on those cultures that don't seem to suffer heart attacks...the French (Red Wine?), those nearer the equator (the sun?), the japanese (iodine from seaweed, high intake of fish and essential fats....not Dr Esselstyn is against this).

Not recommending any of these obviusly - but they are interesting to look at and form your own opinion.  One thing i think is important and that is to take a proactive approach to your health...i'm sure you do, just my thoughts.  :-)
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Avatar_n_tn
also, avoid stress.  My dad was known to 'thrive' on stress....loved it, was a real dynamic character and no one ever thought anything would happen to him, he was larger than life.  He didn't thrive on it at all.

he slept 4 hours a night even at age 64 and worked 12 hour days or longer.

I say get your sleep and don't let anyone push you into doing more hours at work than is healthy.
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976897_tn?1379171202
I remember a class in cardiac rehab where they discussed the effect of diet on atherosclerosis. It used to be strongly believed that certain foods were the reason why other countries had such a lower rate of heart disease but this view has swayed recently. It's true that the French do eat much more saturated fats than us Brits, and it's also true as you say that red wine was investigated. I worked in France for two years and their whole lifestyle is so very different and I believe this is the same in most mediterranean countries. In England, when it's lunchtime for example, it's quite the fashion to grab a sandwich or burger and eat it in the office while still working. I admit more people are switching to salads, but they still eat them in the office while working. Not the French, it's not their way. They go home or to a restaurant etc and sit for at least 1.5 hours, relaxed and enjoying their food. They are not stressed out when they eat which is the total opposite of the English. Food is like a cultural thing to the French, they take it very seriously. In the UK, if the wrapper says it's edible, we eat it lol.
I think if they developed something like a stress meter which everyone wore, like a watch, then nearly everyone in the UK would be having high readings most of the day. It has become so bad that people are losing the ability to 'switch off' from their jobs and depression is becoming a much growing problem. So, as much as I agree food is probably a part of the equation, I believe it's HOW we eat that food that's a bigger part.
What do you think?
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1542723_tn?1294451038

First of all thank you for your replies, Kenkeith, Flycaster, Jrbon, Rosemary ( sorry about your dad ) and fellow Brit., Ed.

No, Ed I actually don't look at CABG as the ultimate solution, ultimate nightmare yes, solution no. One of the the chaps at my Cardiac Rehab class had CABG and you can call me soft but I was not impressed by the decoration the surgeon had left on his chest and his leg.

I guess what I want to hear is that as long as I follow the healthy lifestyle, take my medicine and with bit of luck I reach retirement age and enjoy a few years thereafter without going through anymore "events" or "operations" such as CABG.

I got the Heart Attack in April 2010. Three years before I went through a difficult patch with my wife, before I even got over this my business went down and since I had mortaged my home as collateral,  I lost home, business and was declared bankrupt. Oh most important I had also lost my family.

I exercised regularly but as the stress mounted I backed off, instead my became a chain smoker, ate take outs, mostly Fish 'n Chips ( to be fair I had always been partial to regular visits to my local chippy. During this period I don't think I did not chill out even for a minute. I was continously stressed. Last thing I did was smoke, first thing was I smoked.

Eventually I lost even my car. A 46 year old guy and I was back to where I was when I was 16 - Worse, with 30 years of wear and tear. For the next six months zero exercise, smoke all day, eat take out food with general careless approach to everything. Then one day I got my acty togather, started to pullmyself up again and as part of this regeneration of myself I began exercise weights, jogs and walks. I had gained some weight but not as much as you 'd think considering the food I was eating, reason was I have always had high metabolic rate. Its very easy for me to lose weight even at my age.

A week into this regen., in the local park after having walked some 2 miles I began to jog ( first time in half a year ) and bang. Tightness in chest, pain in sternum, can't breath, sweat like I am in Sahara, left hand goes numb. I simply can't jog, find a bench , then walk home slowly refusing to accept that I am having a Heart Attack when my gut tells me its a MI.

An hour later when sypmptoms don't go away and I am struggling to breath I call 999 ( well my sister actually calls 999 ) who respond within minutes. Paramedics, Ecg and confirm I am having MI. Next thing sirens and emergency PCI with one stent.

Once again thanks to everybody for their replies.

Ps. Does anybody know about Rosuvastatin and its possible effects on Atherosclorsis ... I am thinking here of regression?


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1542723_tn?1294451038

One more thing ..... because of the stress I would smoke too much and get headaches. Then I would take paracetemol tablets, then started taking co codomol tablets, then at some point if I am honest I am became addicted to them. When I started to get my act togather I stopped taking any painkillers and had been off them for 2 weeks when I got the MI.

Suppose when I look back and if I am honest with all the stress and my lifestyle I was a walking "would be Heart Attack".

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