stent rejection clot wont disolve

[Mrsbigedt]

My husband experienced his 4th heart attack last week.  He's still in the hopsital having his 4th angiogram today.  His RCA received a stent in July 2010, bypassed in August 2010, failed-restented with a DES in October 2010 placed on effeint/aspirin and clotted again last week.  The issue/phenomenon is that the clot won'd disolve depsite agressive drug therapy that is now baffling others.  He is on IV Reopro and heparin while still receiving effient.  No one seems to understand why the clot is still there.  Any thoughts?  I am being told to re-bypass is not an option-I don't understand that either.  

[Mrsbigedt]

I have been working on other opinions.  We are at Cedars-Sinai in Los Angeles.  They have consulted Dr. Kar the "stent expert" and  have been in communication with Cleveland Clinic.  No one has ever heard of this nor can offer a new or different approach.  I find it crazy that my husband, Ed, is the first with this situation.  Even consulted a Hemotologist to see if he has some rare blood disorder (he doesn't).  Just hoping someone out there had a similiar situation...        

[ed34]

Can you go to another hospital and get another opinion? this doesn't sound right to me.
Maybe they don't have the equipment. Ask if they used an angiojet. This delivers high pressure jets of saline solution to the clot, breaking it up, and the pieces are sucked up the catheter tube.

[Mrsbigedt]

it was a giant clot around the stent.  For whatever reason they could only successfully remove part of it and he was given a disolving agent for several hours through the cath to no avail.  this is day 12 in cardiac icu and my husband is going out of his mind.  They are now going to end the IV drugs and send him home on a cocktail of blood thinners and see him in a couple of weeks for yet another angio.  Fortunately, there is blood flow of around 30% and if the cocktail works it will stay that way or slow the growth of the clot.  The Dr.'s aren't optomistic.  He will occlude again and another heart attack is inevitable unless this clotting can get under control.  He has the Taxus DES and it "looks good".  They won't consider an additional stent and revascularization isn't an option.    

[ed34]

In usual cases a balloon is inflated downstream from a clot and a tiny tube is used to suck out the thrombus material. Sometimes a dissolving agent is used to help break it up. They managed to get 'some' of the thrombus out, but did they say why they had to leave the rest in there? It wouldn't appear to be in a difficult position because they've already removed a portion of it. Have they given any more details?

[Mrsbigedt]

Yes, he has had 4 angiograms in 8 days.  they are continuing to check his PT-INR @ regular intervals, while I don't know the number, I can imagine it to be high given medications that he is continuing.  It doesn't appear by my conversations restenting is an option until this clot is remedied.  The clot was partially removed in the first angio and Reopro was directed to the clot-the second angio 2 days later showed no change.  He is now on the the reopro and heparin iv drip for the 4th day.  He seems to be a phenomenon.  I have always known my husband is special, but this is too concerning.  When a top cardiologist is shaking his head and saying there is nothing we can do.  Any one have any history with Cedars-Sinai Dr Kar?  

[ed34]

Is it the DES which has clotted? did they do an angiogram to confirm this?
If they tested his INR through a blood test, then I too can't see why a thrombus would form with such strong medication. Unless however the blockage is a ruptured lesion, which would consist of fats and other cells. I don't believe such blockages would be dissolved by any anti-coagulants which is why emergency stenting is performed with such cases.
I had a triple bypass in Sept 07 and that completely failed by Dec 07. If a bypass fails so quickly you are deemed unsuitable for such intervention. In some people, grafts just close up very quickly and the reasons are still not clear.
There is also the possibility of scar tissue forming inside a DES. A stent is a mesh with plenty of gaps inbetween the struts. The drug coating on a DES will therefore only touch about 20% of the artery lining leaving 80% open to the possibility of forming scar tissue and re-blocking.