Aa
heart disease
My son has had 5 stents since May of 2010 and the stent keeps closing because the branch is too small so his cardiologists say to let the branch close on its own and it will reroute and his pain will be gone. May will be 2 years and he is still in pain.
Is there anything that can be done to close this sooner or comfort his pain while waiting?
Is there anything that can be done to close this sooner or comfort his pain while waiting?
Thank you for that drug eluting balloon info!
We will ask his cardio when we see him at an appt. at the end of April, unless something happens that takes us there sooner.
Now just for some background in his history.
He has been having pain at an 8 on the scale, closer together than he did in October of 2011, around the time of the heart catherization.
We are hoping that this means this branch is closer to closing so that he can have peace from the pain that he has had inflicted upon him since May of 2010.
We have to keep in mind, that in May of 2010, when he had 5 stents put in,
he had an artery that required 3 to hold it open and 1 for that small branch. He still was having pain and returned to the hospital, with a small attack which they found that the stent in the little branch had closed and even after they placed another stent to reopen it, he was still having ongoing pain . Not to the point where he felt the need to go back to the ER but on a scale of 1-10 like a 4 or a 6 off and on for all this time til he went back in Oct 2011 and found that the same stent had again closed and the branch was then at 95%. As I said, his cardio said he could put another stent in but it would probably close up too and my son would end up back at the ER with another attack. So their decision was to let this close itself.
We will ask his cardio when we see him at an appt. at the end of April, unless something happens that takes us there sooner.
Now just for some background in his history.
He has been having pain at an 8 on the scale, closer together than he did in October of 2011, around the time of the heart catherization.
We are hoping that this means this branch is closer to closing so that he can have peace from the pain that he has had inflicted upon him since May of 2010.
We have to keep in mind, that in May of 2010, when he had 5 stents put in,
he had an artery that required 3 to hold it open and 1 for that small branch. He still was having pain and returned to the hospital, with a small attack which they found that the stent in the little branch had closed and even after they placed another stent to reopen it, he was still having ongoing pain . Not to the point where he felt the need to go back to the ER but on a scale of 1-10 like a 4 or a 6 off and on for all this time til he went back in Oct 2011 and found that the same stent had again closed and the branch was then at 95%. As I said, his cardio said he could put another stent in but it would probably close up too and my son would end up back at the ER with another attack. So their decision was to let this close itself.
Usually stents re-block due to scar tissue. When the artery repairs itself from being ballooned, the first thing it does is produce scar tissue while under this, the new lining forms. In some people scar tissue grows far more aggressively than in others, causing it to block the artery. What they found in Europe with such patients is that there was only around a 20% chance that the standard ballooning would work. They developed the drug eluting balloon to get around this problem. If you imagine a stent, it's a mesh, so it has a lot of gaps. Only the stent has the drug coating which prohibits scar tissue formation, which means when expanded into the artery, only 10-20% of the artery wall in that area receives the drug. All the artery will in the gaps receive nothing 80-90%. The drug eluting balloon, when expanded, touches all the artery wall, delivering the drug. It's worth enquiring if they have such a device, because there has been a lot of success with them.
Yes they used drug eluting stents in answer to your first question and in answer to your second question, I don't know if they used a drug eluted balloon but they did use the balloon to open and reopen when the stents closed twice on this small branch.
"so they are hoping or seem pretty positive that this will close and reroute the blood and his pain will go"
Well, let's hope they are right, and collateral vessels open to re-route the blood. What I'm trying to say though is that it's a fact that they don't open in everyone. It's a mystery why this is the case. Look at the millions of people for example who have had a heart attack and some heart muscle has died and turned into scar tissue, their collaterals didn't open. My main left artery completely blocked, and yet I didn't know until years later when another vessel blocked and had an angiogram. I didn't know because lots of collaterals had opened and kept me alive.
I would just ask 2 questions because there are no guarantees here.
1. Did they use drug eluting stents or just plain ones.
2. Do they have drug eluting balloons which will push the artery open, and
likely KEEP it open.
I'm not sure that I would want to rely on luck with my heart when there are other options. Not when I could lose some valuable heart muscle.
Well, let's hope they are right, and collateral vessels open to re-route the blood. What I'm trying to say though is that it's a fact that they don't open in everyone. It's a mystery why this is the case. Look at the millions of people for example who have had a heart attack and some heart muscle has died and turned into scar tissue, their collaterals didn't open. My main left artery completely blocked, and yet I didn't know until years later when another vessel blocked and had an angiogram. I didn't know because lots of collaterals had opened and kept me alive.
I would just ask 2 questions because there are no guarantees here.
1. Did they use drug eluting stents or just plain ones.
2. Do they have drug eluting balloons which will push the artery open, and
likely KEEP it open.
I'm not sure that I would want to rely on luck with my heart when there are other options. Not when I could lose some valuable heart muscle.
Hi Ed 34, I don't know if my comment went through because I am having issues with my wifi but my son has had no releif of pain but when he first received the 5 drug eluted stents he ended up going back to the hospital due to a small attack and went under another cath showing stent had closed on very small branch so they put in another stent at that point in May of 2010 he continued to have pain until finally he did get another opinion and said he should have another cath but he had it done by his original cardio.... and in Oct 10, of 2011 it showed all stents were wide open but that same little one closed again for the second time. He said he could put another one in but it would close too and that is it was now 97% closed so they are hoping or seem pretty positive that this will close and reroute the blood and his pain will go but that is the only one that showed to have trouble during the heart cath. All else looked fine
I would just like to add something because I feel really bothered by your circumstances. All Cardiologists are aware that not everyone opens collateral vessels. This is why so many people don't survive heart attacks. If everyone opened collateral vessels when a blockage occurred, then we wouldn't ever know we have heart disease. When his small vessel blocks, which can take many years, or months (nobody can estimate it) then 2 things could happen. He could develop collaterals, but unlikely if they aren't forming already with chest pain. The other outcome will be that heart muscle be suffocated and die in that area and will be unable to give pain. Your son may be under the impression he has developed collaterals because the pain is gone, but it will be because some heart muscle has died. I think you should ask your cardiologist some very serious questions and possibly seek a second opinion.
A good friend of mine went through the same thing. He was told "there is a very high probability that collaterals will open as the artery closes". Well, over the next year his artery fully closed, and it was a branch thankfully. He felt a bit more pain for about an hour, and then it went away never to return. He developed a new blockage a year later, and had an echo scan and nuclear scan. They discovered an area of his heart muscle had died.
I just don't want your son suffering the same outcome because heart muscle doesn't regenerate, once dead, it stays dead.
A good friend of mine went through the same thing. He was told "there is a very high probability that collaterals will open as the artery closes". Well, over the next year his artery fully closed, and it was a branch thankfully. He felt a bit more pain for about an hour, and then it went away never to return. He developed a new blockage a year later, and had an echo scan and nuclear scan. They discovered an area of his heart muscle had died.
I just don't want your son suffering the same outcome because heart muscle doesn't regenerate, once dead, it stays dead.
What your Cardiologist is talking about are collateral vessels forming a natural bypass. These don't work with everyone, and certainly after 2 years you would expect to see the benefits IF they were going to form. It sounds like they feel they are out ideas and just want to see what happens. Any Cardiologist would give a blockage 6 months to form collaterals at the most. Due to the artery being so small, it is likely that scar tissue is causing the re-blockages. You don't mention the type of stent used, but was it drug eluting rather than bare metal? The drug eluting stents were developed many years ago to prohibit the formation of scar tissue in an artery. I don't know where you are from, but Europe developed a drug-eluting balloon for small vessels and has been very successful. The balloon is coated with the same drug as the stent, and when inflated it covers the artery wall with it, stopping scarring. This technique doesn't use a stent.
Have an Answer?
You are reading content posted in the Heart Disease Community
Is a low-fat diet really that heart healthy after all? James D. Nicolantonio, PharmD, urges us to reconsider decades-long dietary guidelines.
Can depression and anxiety cause heart disease? Get the facts in this Missouri Medicine report.
Fish oil, folic acid, vitamin C. Find out if these supplements are heart-healthy or overhyped.
Learn what happens before, during and after a heart attack occurs.
What are the pros and cons of taking fish oil for heart health? Find out in this article from Missouri Medicine.
How to lower your heart attack risk.
