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Saturday, February 23, 2013

New Chest Pains - Learning about Stent Restenosis

Dh is dealing with chest pain again.  I'm a little bit worried, but he doesn't seem to have exertional pain.  In fact, exertion tends to rid him of the pain, so far.

He went surfing last Friday, and while in the water he had no chest pain, and while walking the long walk from the beach to the car he had no chest pain, but when he twisted his body to look back in order to pull the Yukon out of a tight parking spot, he felt the pain.

He feels it when he turns his head to the right, when he bends over, and when he's tired at the end of the day.  

I sincerely hope it's a problem with his muscles or spine instead of his heart.  I do feel encouraged today because he did have some physical activity last night that actually relieved the pain, so I'm hopeful, and no pain this morning.

He is not out of breath, not dizzy, and not fatigued, so I'm crossing my fingers, but since he has revealed that he is having chest pain, I have been on edge and a bit depressed.

In the meantime, I felt I should do some study on stent restenosis, the risks of this happening to Dh, and what symptoms to look for.

Restenosis happens when the artery tissue cells attempt to heal around the stent and make scar tissue that is too thick to allow free flowing blood through the artery.  It used to be that 30 - 40% angioplasty patients with bare metal stents would develop restenosis and end up with a serious heart blockage.  In the past ten years or so, the cardiac care world has wrestled with the development, and much trial and error, which includes the experimentation on many heart patients, Dh included, of drug eluting stents.  Generally, the outcome has been a good one.

Drug eluting stents are coated with chemotherapy drugs that cause the artery tissue around the newly placed stent to resist tissue development, making the development of the tissue much more gradual and less vigorous.

This has taken the early restenosis risk down to single digits.  Dh is currently participating in a later generation clinical trial of the Xience V Everolimus Eluting Coronary drug eluting stent, which he will be in for five years.  Why the five years?

I think it's because the cardiac care world has discovered the drug eluting stents tend to create other complications that the bare metal stents don't - up to five years after the procedure.  These drug eluting stents have been known in some cases, particularly in diabetics, and patients with metabolic syndrome, like DH, to create later complications when the blood thinner medications are discontinued.

You see, when a heart patient receives a stent, he/she is typically placed on a blood thinners like Plavix to prevent blood clots from forming around the stent.  Blood clotting is call thrombosis, and is not restenosis, but another risk of having a stent.  After stent placement, the risk is high for thrombosis development which can lead to artery block and heart attack.  This risk makes the blood thinners imperative.

These are risks you are not usually told about when your spouse is being wheeled into the cath lab prior to surgery, and this probably is because the risks outweigh the benefits in a big way.

With drug eluting stents, there have been cases reported of patients developing thrombosis after the blood thinners are stopped.  When the first trials came out during the early use of drug eluting stents, interventional cardiologists were excited by the results of restenosis prevention.  But, in time, a dilemma developed when it was found that late thrombosis was a risk they did not anticipate, and this has been a noted risk up to five years after stent placement!

Dh's stent is a late generation stent, which is hoped to prevent this risk of late thrombosis.  He will have to be on blood thinners for at least a year, and I'm hoping that clinical trials done up to that point will show that these newer generation stents are less prone to late thrombosis.  I am hopeful that they are, but extremely cautious.

When his stents were placed, I thought that would be the end of my worries, but I'm now resigning myself to the fact that I will always have to be on guard, watching him to see he if is developing any blockage symptoms.  We all have our own trials and situations that seem to be chronic, and this is one of ours that will certainly keep me on my knees for years to come.  As I have said before, as Dh's heartmate, part of my mission in life is to help him keep his heart healthy.  Metal stents create inflammation by the very nature of them not being a perfectly matched human tissue for DH's arteries, and this makes keeping Dh on a diet that naturally keeps the blood less "clottable" very important, although I'm not sure that thrombosis can be completely avoided with just diet.  But what I do know is that diabetics and Syndrome X patients have higher arterial inflammation, so my call to diet vigilance has been sounded and heeded.

My next post will probably be a research paper on the stent that has been placed into Dh's arteries.


  1. Did you ever figure out the cause of the symptoms listed above

    "He feels it when he turns his head to the right, when he bends over, and when he's tired at the end of the day."

    I have exactly the same problem; can do heavy exertion activities but twisting my body (like backing up a car) will cause middle chest pain. I've also had 2 stents put int on my LAD much to the surprise of all the doctors who kept saying there's no way I have heart issues because of my age and lifestyle.

    thanks for the blog.

  2. Hi Merlin,

    You're welcome. I'm sorry to hear you have been through this journey too. We haven't found any cause to his pain but he only has it when he has a cold and is run down from that. We asked the doctor in June and she said that since he wasn't having the pain during exertion, it was musculoskeletal and not to worry. The week after that he went camping with our five sons and did water sports, water trampling, hiking, etc, and no issues. We don't worry about it anymore. When he gets the pain, we go for a brisk walk and it goes away.