stent removal

[mfr]

Once a heart stent has collapsed, can it be removed?

[atwt]

   My doctor tells me that I will never be able to remove my stents.  Two arteries 95% blocked and one 80%.  I have learned that taking atorvastatin may lead to increased blood sugar levels, and possible diabetes in the future.  I made a big mistake in not getting a second and third opinion before consenting to this procedure.  No symtoms were ever reported to my doctor, and I felt he was very anxious ot procede with this operation, rather than suggest an alternative approach.  Of course I take full responsibility for my decision - I still regret having the stents placed !  

[Shaoguan56_]

I have the similar experience, the doctor seems to eager to go ahead with the procedure without sharing knowledge about alternatives!!! I have made the same mistake not getting the second opinion as I was kind of "pushed" to make a hasty decision! They put three stents inside me for 90%, 70%, and 70%! Horrible!
Is there a way to remove them?

[jimabcde]

     I'm 66.Last year I had a quad coronary bypass.  I also went to a vascular surgeon to get my left iliac artery stented for PAD. After the operation the surgeon informed me that he also threw in two on my right leg to "even the flow". It's bad enough that I didn't need or request these, but one of these is is new flexible stent he put in the angle of my right hip.
     The thing is rated for a mean lifetime of 40,000 bends before metal fatigue produces fractures and the thing begins shredding my artery. When this thing breaks, which is 100% guaranteed down the road, what can I expect?
   I've read that there is a 40% mortality rate in arterial stent removal. I've also read that arterial stents are never removed in case of failure, just re-stented over. However, this thing will, of necessity, have to be removed!  
   I've looked around but I haven't come across any literature on procedures to remove these new flex stents when they eventually fail.   I'm seriously worried.Every time I sit, stand, or take a step, I'm that much closer to the stent failing.
    Have failure modes and removal options been studied for these new flexible stents?
   Specifically what will be the odds of me keeping my leg, or better yet, surviving the removal of the stent.
  I've been told, unofficially, that when this new flexible stent finally fractures, which the laws of physics guarantee, it will absolutely necessitate removal of either the stent itself or the section of artery it occupies, which means losing my leg at the hip. Is this correct?
    It seems to me that this new flex stent technology has been implemented without adequate forethought being given to the consequences when the devices reach their flex lifetime and inevitably fail.


Jim

    
  
      
      

[ed34]

"Stents are removed in the same fashion inwhich they are placed."

I had a stent in Feb 2007 and new artery tissue has grown across/through the scaffolding. So in effect, the stent is under the surface of the artery lining now. How can they remove it without tearing my artery apart?

[ed34]

Are you sure it's due to the Nickel? From what I understand, Nickel usually reacts with the skin, but it's actual effect inside the body is not really known. A test was performed with half the patients having nickel stents, and half not. There was no difference between them, including those with Nickel allergies.

[Rolo1950]

I need answers I am allergic to nickel and I told them this but they still put the stent in now I am having all kinds of problem the doctors will not even talk to me about the problem where can I go for help

[ed34]

I have been on atorvastatin since 2007 (40mg) and for the last 2 weeks (80mg) and no side effects, no raised sugar levels and no diabetes yet. I haven't yet seen a report explaining in detail how atorvastatin can increase sugar levels. I have seen 'experts claim' in many statements, but no chemical information as to how this occurs. As far as I know, whether on statins or not, those patients may have developed increased sugar levels. Ironically, thousands of diabetic patients put onto a trial gave the results that coronary events and strokes dropped by a third. None of the diabetic patients had complications with sugar levels and so I wonder if yet again this claim has any true scientific foundation. Logically, you would expect those with insulin problems to have the most sensitivity to statins, yet this simply doesn't appear to be the case.
With regards to your existing stents, have they re-blocked? or are you saying that you have new blockages elsewhere now?

[ed34]

nothing. Where did you hear a stent last 15 years? that is a bypass which is different altogether. Your stent is now embedded in your artery wall and a new lining has grown through that section of the artery. The stent is in there for the rest of your life and doesn't rot or wear out.

[Adamgee]

Hi following on from your answer. I was 32 when I had one stent implanted if the lifetime of the stent is 15 years what is it going to be removed when I hit that age as I have now been living a very fit and healthy lifestyle for last 5 years

[ed34]

There are a few things which concern me over your thoughts. First off, does the 40,000 involve bending the stent round completely? because no artery is going to have that amount of movement. Second, which artery has had the stent? was it the femoral? because even that artery doesn't move much at all when you walk or run. Third, who told you that a broken stent will tear its way through an artery? Surely it would simply become two stents, end to end, which are very commonly used. I have 5 stents end to end in my LAD and my heart is moving the artery but the stents haven't chewed through the artery. Personally, I think if they believed it would be such an issue, then Doctors/surgeons would have pointed this out and refused the technology.

[jimabcde]

I don't know if your reply was to me, ed, but I'm familiar with all that. I know the stent becomes imbedded into the artery's tissue.I understand that it becomes a scaffold that is incorporated into the artery wall itself.
  What I am concerned with is this new class of stents that are designed to flex and bend.  I have one in the angle of my hip, and manufacturer specs state that I have a mean number of bends before the stent is GUARANTEED to break. Every step I take, every time I sit or stand I'm one flex closer to the mfg rating of 40,00 bends at which time I can expect the wires to fracture and begin chewing thru my artey. Metallurgy and the laws of physics guarantee that it will fail thru metal fatigue!
.
   I'm trying to find out my chances of survival or saving my leg when the inevitable does happens.

[ed34]

I don't think there is really any difference with drug/bare stents long term, not once they are covered with a new lining. The small benefit seems to be with short term, the drug slightly inhibits scar tissue growth. The problem though is that a drug eluting stent is still mesh, so there are a lot of holes which do not deliver the drug to tissue. Estimates say that around 10-20% of the area around the stent receives the drug. This still leaves a lot of opportunity for scar tissue formation. In Europe the Drug eluting balloon was developed. It can be used for arteries which are too small for stents, and as a preparation for drug eluting stent delivery. The balloon delivers the drug to 95-100% of the artery.

[ed34]

I think you are perhaps misunderstanding the function of a stent. It isn't always in the inner part of the artery (lumen), where the blood flows. It acts as a mesh scaffolding to hold the artery open, and allow repair to take place. In a matter of weeks/months the artery makes a new lining (endothelium) which grows through the stent. This will greatly reinforce the stent too. In a few weeks the stent is basically buried in the artery wall. When I had an angiogram a couple of years ago, they couldn't see the stents I had placed a year before. They had to refer to paperwork to locate their position because my artery was like new. I think after the 2-3 weeks you can stop counting the twists and turns, because the stent will be buried and reinforced in the artery wall.

[ed34]

They will have to look at angiogram images and make a decision based on the circumstances. It may be possible for them to balloon the site and insert a new stent inside the old one. It could be that the disease is only partially in the stent, meaning they may insert a long stent to cover all the old stent plus any new diseased section next to it. It maybe that only a part of the new stent has to go inside the old one. It depends on the circumstances.

[blondepompom]

A cardiologist placed a stint in my right renal artery 10 years ago. I now am having trouble with my bp due to a slight narrowing at the stint site. My urologist us sending me back to Duke university to see about a stint replacement. What information can you possibly give me on this.

[EPI102]

I had a stent placed in a blocked LAD. I was born with a bi-directional atrial shunt (hole) which was determined to be a birth defect. Due to the birth defect blood passes thru the shunt losing  oxygen and allowing tiny clots to form which were passed to the brain causing and other parts of the body causing (a TIA in 1997 and a mild stroke in 2005) the heart attack. The heart attack was due to the blocked artery and the doctor did not know if the artery was blocked due to tinay clots from the birth defect or plaque build up.  The attending nurse advised my family that I could follow the regime of my doctor and dietician and the stent could be surgically removed. I have since followed my diet and reduced my weight. I anticipate having the stent removed. There are also two types of stent; the drug eluting stent and the metal stent. I had the metal stent inserted in my LAD. Stents are removed in the same fashion inwhich they are placed.

[kenkeith]

Your mother has the symptoms of reduced cardiac output.  And she should contact the doctor to get treatment.  A low cardiac output can cause lung edema because the blood received from the lungs backs up into the lungs because the heart does not have enough strength to pump adequately.  What do tests indicate?

[dipindhingra]

I am sorry. I am not able to track my posts, as I dont recieve any updates, so I check manually now that you replied me here. Well thanks a lot for your replies. Its very valuable.

And coming back to what you said, the ASD that she is having has not enlarged since last 15years and even her heart size has not grown or shrunk. Also the ASD has not extended to the portion in which there is blockage. Actually ASD is separate problem.

But right now, its blockage. My mother is not able to walk even 2 steps ow, if she walks or even go to toilet or eat a little more food she feels breathlessness.And she asks for water all time. Currently she takes lots of sorbitrate tablets to keep her heart stable during such thing.

I also heard my father saying yesterday that in the latest ASD report, it shows there is a leakage in a valve also.


I really dont know how to help my mom.

[kenkeith]

Dipin, I answered this thread before reading your e-mail.  If you have any further questions you can followup by e-mail if you wish.  Thanks for your response.

[ed34]

"Docs said stent has a life of 4-5 yrs, after that you need to change"

I have one which has been in my obtuse marginal (OM1) coronary artery for over three years now. It is still fully open with no sign of disease or other problems. I'm not sure where your Doctor got the information from. I can't see my stent developing problems in the next year or so.

[kenkeith]

Qoute:"To: gman and kenkeith
My mom has over 75% blockage in one artery and few yrs back she developed ASD(hole) in heart for which she was recommended open heart surgery.

And now for blokcage , they suggest stent.Docs said stent has a life of 4-5 yrs, after that you need to change.
is it a risky procedure. please suggest"

>>>>The life of stent implant can be permanent, but it is necessary to stop or slow the progession of plaque buildup within the stent as well as systemically.  With 75% blockage there may not be a need to treat other than medication.  It is not risky to have a stent implant.  The individual remains awake but given medication for relaxation....there is no discomfort whatsoever and no anxiety.

ASD is a hole in the wall that separates the two upper chambers and usually congenital. Do you mean the hole has progressed where treatment is required?

For some insight and it ASD appears to be congenital: "Some congenital heart defects may have a genetic link, either occurring due to a defect in a gene, a chromosome abnormality, or environmental exposure, causing heart problems to occur more often in certain families. Most atrial septal defects occur sporadically (by chance), with no clear reason for their development."

If and when the defect becomes a problem, there may be a cause for intervention. The problem would be what is called shunting and that means there is blood passing from one upper chamber to the other side's upper chamber (left to right due to higher pressure in the left atrium.  A small opening in the atrial septum allows a small amount of blood to pass through from the left atrium to the right atrium. A large opening allows more blood to pass through and mix with the normal blood flow in the right heart. Extra blood causes higher pressure in the blood vessels in the lungs. The larger the volume of blood that goes to the lungs, the higher the pressure in the lungs. Can/will enlarge right atrium as well as respiratory problems.

Usually, if there is going be open heart surgery, there will be a bypass of any occlusions rather than stent.

[ed34]

Stents can be removed during the angioplasty procedure, but this possibility is short lived as tissue forms and bonds to the stent. Special tools collapse the stent, draw it into a tiny sheath to hold it collapsed, and then it can be withdrawn from the body. This is not a possibility when tissue has attached to the stent, then an endarterectomy has to be performed. An endarterectomy is a normal procedure prior to bypass grafting anyway, it creates a clear area in the native vessel to accept a new feed.

[dipindhingra]

My mom has over 75% blockage in one artery and few yrs back she developed ASD(hole) in heart for which she was recommended open heart surgery.

And now for blokcage , they suggest stent.Docs said stent has a life of 4-5 yrs, after that you need to change.
is it a risky procedure. please suggest


Dipin
India

[kenkeith]

It seems to me if you were to need a bypass the stent that is blocked can be removed at the time of the bypass if that is not the only option, however, a successful rotor rootering will open the occluded location and then sten again or not.

When I mentioned distal location, I as thinking that surgeon can reroute the blood flow to feed the deficit area.  Your hypothesis is really a question for a surgeon.  

[gman2009]

What if the most distal part of the downstream location had a stent?  I believe the article I cited was for cases such as that.  Remove the stent and then bypass to that location.  My cardiologist has already informed me that I cannot bypass due to the number of stetns in my LAD.  My circumflex and RCA look like they are healing really well, but my LAD is causing me great difficulty.  I barely survived the attack as the occlusion was, for all intensive purposes, 100%.  I was only saved by a collateral that was barely keeping some of the muscle alive.  I have since recovered competely and the tissue death reversed (which means it was not quite dead).  My LVEF went from 50% during my most recent surgery two days ago to over 60%.