Stent longevity and homocysteine

[Chris_UK]

I am a 53 year old male in the UK. I have no obvious risk factors for CHD. I don't smoke, no family history, I'm not over weight etc. I had a stent fitted in July 2004. This was to the Left circumflex (LCX) and obtuse marginal branch. This was the only area blocked. I was told the main arteries were 30% clogged.
At the time my cholesterol was 202 with high triglycerides. My level now is 137. Breakdown as follows:

Triglyceride = 30.5
HDL = 50
LDL = 68.7
Chol/HDL ratio = 103.1
Homocysteine = 871

I am now on high dose vitamin B6, B12 and folic acid supplements to reduce the homocysteine level.
I take a brisk 30 minute walk 6 days a week and have a nutritionist making sure I eat the correct food. All in all I think I'm doing the best I can. My BMI is a little high at 24.5 but I'm working on that also.

My questions are. How long would a stent (not drug eluding) be expected to stay open given my current regime. I realise there is no definitive answer, but I've no idea if it is a short term fix or if it could last 20 years or so.

What happens if it cloggs up? Can they be re-stented?

Is homocysteine recognised as a marker for heart disease? My doctor had never heard of it.

Thanks in advance.
Chris

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[jerseyj]

I had a severe intamyocardial bridge which was stented with the bare metal stents, 3 in all , the cardiologist who did it placed them from top to bottom, they re-stenosed(sp)with scar tissue in less than 6 months, i was then cathed again, it was 90% blocked and the had to roto blade the scar tissue out, and then he placed 3 more drug coated stents inside of the bare metal stents, that lasted for about 4 months, and i was cathed again, and it was again 80% blocked with scar tissue, the again placed 3 more drug coated stents inside the other drug coated stents, inside of the bare metal stents, so now i have a total of 9 stents in my LAD from stem to stern, they are now blocked again with scar tissue 95% and the problem is that i have what is referred to as "full metal jacket" the cardiologist never allowed for space for bypass surgery if needed, so now i have seen 4 surgeons, 3 of which say that bypassing is impossible because they cannot perform a proper anastamosis because the metal stents are in the way, i have found one surgeon who may actually try and remove the stents during an endarterectomy, or imay have to settle with a TMR procedure, i guess the point of my story is that i HATE stents, if i didnt have them i would have been able to have a regular bypass, but now at 31 i am now facing a much more invasive surgery or a last ditch effort with TMR.

[Cleveland Clinic]

Chris_UK,

How long would a stent (not drug eluding) be expected to stay open given my current regime. I realise there is no definitive answer, but I've no idea if it is a short term fix or if it could last 20 years or so.

There is no definite answer. Some people have problems within months after having a stent placed while others may go indefinitely without any problems. There are 2 classes of stents -- bare metal and drug coated. The bare metal tend to have more problems with restenosis.


What happens if it cloggs up? Can they be re-stented?

You would probably get  typical anginal symptoms if you have restenosis of the stent.  In that case depending on the way the stent looks it could either be reopend with just a balloon or another stent may be placed inside of it.

Is homocysteine recognised as a marker for heart disease? My doctor had never heard of it.

It is. Unfortunately it is unclear if reducing homocysteine actually decreases events. The treatment for it is benign and that is why we usually treat it in patients that have had a problem.