How do I get into a Heart Stent Study

[financebruce1]

I have eight stents placed in me in 2009.

I would like to get into a study, I am told I will never be off of Plavix.
Can I ask where a person can research articles on living with this many stents,  I have them in all of my main arteries and have had two angiograms which report that the left portion of heart bottom is damaged.

Looking to learn more about life expectency and why pain seems to come back

[jrbon]

Hi, with only 5 stents (8cm long), my advise is that now the least of your problems are the stents... just enjoy them.

In any case if you want to research this or any other medical topic, my advise is to start here, (this is serious information, perhaps you need to study a bit before you can understand it) :

http://www.ncbi.nlm.nih.gov/pmc/

As per the damage part of the heart, they cannot get it from an angiography, in my experience I got the most information from a very well done echo .. the report is amazing from the amount of information that it has.

The important parameters there are the size on the cavities to see if they are dilated or not and the Ejection fraction (the % of blood that your heart is pumping), how every wall of your heart is moving and what the status of the valves is.

If you still has angina, and your doctor says that your main vessels are ok, then a cardiac MRI may be of interest because it will show exactly what areas of the muscle are receiving blood and which not.

Hope this help,

Jesus

[ed34]

Hi, and welcome to medhelp :)
Well, I've had just 6 stents but if we put them end to end, I think I would beat you on mileage :) , I personally think stents are great, they are in my opinion the future and will continue to evolve. Even valves are being fitted now using these techniques which is fantastic for recovery time in a patient. Kenkeith explained that I have had a triple bypass, but it wasn't much good because it failed a quarter of the way through my recovery (3 mths). With regards to Plavix, there is no evidence to suggest that this medication provides any benefits after 12 months. There were a few cases in the US where late stenosis occurred after plavix was stopped after 12 months, so this has caused some questions, but it doesn't prove taking plavix for longer would have prevented that restenosis. I had my first DES in Feb 2007 and in May 2008 I stopped my Plavix. It caused no problems for me coming off the medication and then I hard 5 of the longest available stents put into my LAD in sept 09, so plavix was started again and I'm due to come off them now. I have no worries about coming off that medication, mainly because it makes breathing a bit heavy for me. When they gave me the initial 6 pills before my last angioplasty I could feel my chest get really heavy.
With regards to your heart damage at the bottom of the left ventricle,  I'm not sure if you can tell this from an angiogram? I realise you can see impairment of wall movement, but to simply believe there is enough blood flow is not accurate.
Before I had my last 5 stents to open my LAD, I told the cardiologist to look for 2 small blockages in the branches off the bottom of the vessel, because I would not have full benefits without these being treated. When the procedure was finished, and I was able to concentrate from the effects of the huge amounts of meds, he said "I went as far down the LAD as possible, but it got quite sticky towards the bottom so I stopped". Doing a miracle of a procedure to remove a total occlusion, over an inch long and on a curve, to complain about fat being soft and sticky is plain stupid. This is ideal for ballooning and does a lot less damage to an artery when compressed. Those blockages were not seen during my 6 angiograms, they were spotted by a cardiologist who sat at a computer screen 2 years ago looking at the images. Now I have impairment with wall movement under stress at the bottom of the left ventricle, but this is not damage, it's simply a restricted blood flow. I now have a super job of fighting to get more stents which no cardiologist is happy about. They keep speaking of risk, but it has to be less risky than the ones I've just had installed. And, how do you quantify risk? Does a patient who is 49 and always been energic have to simply sit back and say "thats it then"? no they don't. Everytime I cross the road I take a risk, everytime I get in a car I take a risk, everytime I walk down my stairs I'm taking a risk. Life is full of risk if you choose to look at it that way. I will fight to get this last part sorted.
As for life expectancy, well nobody can truly answer that. I know people who have had stents and have been leading a normal life for 10 years now. A stent doesn't shorten life, a new lining in the artery forms inside the stent, embedding the stent in the wall, so it doesn't go anywhere and it doesn't rot causing issues. It simply becomes a part of your artery and you should have less problems than you had before the stenting because blood flow is back to normal. Before these latest 5 stents, I couldn't breathe cold air without collapsing. I've been out shovelling snow and making a snowman this week.
Some people I've noticed, just don't seem to get on with stents, they keep re-blocking or giving lots of problems. My conclusion is that it's down to the expertise of the cardiologist. If you imagine a lot of plaque, and I mean hard plaque, and a cardiologist simply balloons this, squashing it into the artery wall, then the plaque isn't going to be squashed, but the artery will be deformed to accept it. This will cause artery damage and problems after the stent is fitted. In ALL my stents, the excess plaque has been removed before ballooning. Either by rotablation or laser. They tried a laser on my last blockage but the abundance of plaque was too high, the laser really struggled. So they sent a diamond tipped cutter through the blockage guided by the catheter wire. This was fascinating to watch on the monitor because you couldn't see anything except a black dot showing its location. It was obvious where it was though, the blood flow directly behind it was around 10x greater and the lumen became huge. He sent it down the LAD twice, covering about three quarters of the length of the vessel and then stented the lot. In the future, I believe they may be using biodegradable stents which will dissolve after about three to six months. However, there is still some amount of research to be done in labs to establish the longer term effects. It's the same story, it depends on the cardiologist. If sharp, hard plaque is squashed into an artery, damaging muscle layers, then when the stent dissolves, can the artery stay open?
Most hospitals will let you purchase a copy of your angiogram. Perhaps you should do this and send it to some research hospitals, getting new opinions on the state of the apex of the left ventricle. Perhaps they will see vessel problems which your cardiologist has over looked.
Research is fine over the internet using google, but a lot of information is not very accurate or outdated. The best thing to do is write questions down and ask your cardiologist next time you see him. You can get a rough idea first from the internet, so you understand what he is talking about, but you will usually find the replies are different from those on the internet.
One last thing to consider, and something which seems to be making cardiologists look at blockages in a different way. You may have a 10-30% blockage in your lower LAD, but your cardiologist may be 'assuming' it's not enough to cause your ventricle to have problems. This has been shown to be false now. A sensor on a catheter wire (FFR) can detect the flow rate and pressure of blood around it. When it passes through any blockage, the difference will be seen and some small blockages have shown a huge drop, whereas some very large blockages have shown negligable changes. So size doesn't count.

[Flycaster305]

I also have eight stents, they are in all three major heart arteries, seven of them were inserted within eighteen months about six years ago.  Half of my stents are drug-elluting, half are bare-metal.  I was also told initially  I would be on Plavix the rest of my life.  However, I really worked hard to change my risk factors... of course I didn't smoke, I quit eating red meat, lost a great deal of weight,  took the good drugs recommended by my doctor, and exercised daily.  I've kept up this routine and my cholesterol level dropped dramatically, and 1.5 years ago, my Plavix level was cut in half by my doc, then 1/4, now I'm Plavix free and doing great.  I have other health issues that compromise the use of Plavix, so I was very motivated to get off Plavix.  I do take 81mg aspirin daily.
Eliminating my risk factors seem to have worked for me, but keep in mind I'm not a health professional.  






  

[kenkeith]

When ed returns to the forum in about 12 hours (UK hours) he can help you understand what you can expect or what you should expect with that many stents.  He has about as many stents as you have and has an interest in the subject and has done some research on the subject. I believe he continues to have pain as well and if remember correctly he has had a bypass.

I don't believe there is any published medical literature that supports giving plavix for life. I have had a stent procedure and I have read on the subject and plavix is recommended with aspirin for a about a year, and then only aspirin...that has been my experience.  There is evidence that DES (stents) have a small risk of restenosis for about a year, and plavix has helped prevent that from happening...after a year restenosis is unlikely and no need for plavix..

Have you had an echocardiogram?  That would show any heart cell damage as well as the effect of the damage on the heart's ability to adequately pump.

Thanks for your questions, take care.