Clopidogrel bare metal stent
Common Questions and Answers about Clopidogrel bare metal stent
plavix
I have a bare metal stent in LAD for last nine months. Looks like everything is OK. I also understand that if restenosis does not take place for 8-9 months time it may not take place thereafter. I thought my worry is over.
But just few minutes back I mentioned this to my cardiologist who said that there is something called "late restenosis" in BMS which can take place much later. Now what do I do??
At 18-month follow-up, there was no difference between patients with a drug-eluting or bare-metal stent in cumulative rates of death or myocardial infarction (MI). However, after clopidogrel discontinuation patients receiving drug-eluting vs bare-metal stents experienced higher rates of death and MI (4.9% vs 1.3%, respectively). These results have created uncertainty regarding the minimal necessary duration of antiplatelet therapy after drug-eluting stent implantation.
For a DES stent they normally keep you on it for a whole year, as for bare metal stents(BMS) the period is much shorter. It is very risky to stop Effient before the planned end date. An in-stent-thrombosis is often deadly. Your cardiologist will tell you when it is safe to stop Effient.
Did you discuss stopping Effient with your cardiologist? If not, I would strongly advice you to contact him ASAP.
I have a bare metal stent implanted in my LAD following MI. My LCx is also 100% blocked but is getting blood supply via RCA and now opened LAD. My EF is 30%. Now eight months have passed since implantation of stent. A repeat angio four months after stent implant showed no restenosis. So far it does not look like as if I have problem. But having gone through literature and from some of the responses in this forum, it appears that it is only matter of time that restenosis will take place.
At that time there was said to be evidence that Plavix and aspirin helped prevent restenosis with DES....many cardiologists stopped using DES and went back to bare metal...sales dropped for DES!
In an extraordinary hearing of the FDA in late 2006, the recommendation was to continue Plavix therapy for at least 12 months after DES.
We are learning more and more about drug eluting stents and are finding out that these stents may not always "mature", ie become coated with native lining, thereby, predisposing them to stent thrombosis, a life-threatening condition. I would stay on the plavix and the ASA as long as possible. not only do they prevent stent thrombosis, they actually increase your longevity.
However, what we have to realise is that these were developed for a very good reason. If Bare metal stents were so good, why would they invest so much money in research to develop the DES. If there are no problems with something or the problems only occurred very rarely, it is likely investment would be channeled into something more worthwhile.
Bare Metal Stents have the problems associated with restenosis more than Drug Eluting Stents, but DES can still suffer restenosis in some people.
so I assume you had bare metal stents inserted? These are notorious for restenosis, hence the large amount of research and development that went into producing the drug eluting stent, which inhibit scar tissue growth in the stent far more significantly. What options do you have? well, there are just three as far as I can see. First is to try and give a better flow through the bypass conduits by stenting them. Second is to do another bypass procedure.
I've only heard of two. This is usually when the first stent was a bare metal variety and has formed scar tissue, causing restenosis. Then a drug eluting stent is inserted inside which is coated with chemicals to inhibit scar tissue formation. I know that bare metal stents are cheaper but I really don't know why they don't bin them now.
His Plavix should continue for either several months up to 1-2 years depending on the type of stent he received at the time of his percutaneous coronary intervention (bare metal stent vs. drug-eluting). As with most medications, daily compliance with all of these is imperative for maintaining healthy cardiovascular fitness.
Drug eluding stents (DES) are more susceptible to restenosis than bare metal stent up to about a year or more. Studies have shown and the consensus is to medicate with Plavix and aspirin for that time period. Both medications are anti-platelete agents but have different mechanisms to prevent clotting and the doctor has no fault.
As your angioplasty was so recent, I would doubt if you have any further blockage issues, unless they used bare metal stents rather than drug eluting ones. Bare metal stents are prone to restenose in some people because you grow too much scar tissue in the artery where it attempts to repair itself. Drug eluting stents carry a chemical which inhibits this.
some stents are coated to prevent restinosis (blockages) and some are bare metal stents, but sometimes the coated stents will plug up, especially if one isn't taking a blood thinning drug. I have both. Coated stents are thicker and because my heart arteries are small, most of my stents are bare metal.
I'm betting this is confusing to you. It's a confusing issue. My suggestion is to become as well educated as you can regarding Cardiac Artery Disease (CAD).
first one being in the year 2001 to lad and rca with bare metal stent .2nd being in the yr. 2006 to circumflex .Now ,recently two weeks back he developed chest pain and when angiogram was done it showed 100 % block over rca stent and 50-60% block in lad .Stenting was done to rca with pzifer stent .Now ,my concern is his block in the lad - it approximates 50 -60 % .
In fact it is not recommended for bare metal stent...up to about a year with drug eluding stents. There is a high risk for excessive bleeding, and that risk according what I read with your post was unnecessary.
Most doctors medicate with aspirin only as an anti-platelet drug. You should see another cardiologist as there is absolutely no evidence to support long term therapy with plavix.
I would just keep to the medications prescribed and eat a healthy diet. The Clopidogrel is important for the Stent and the drug coating on the stent will help to inhibit the formation of scar tissue.
It sounds as though scar tissue formed inside the stent, making me wonder if it was a bare metal stent rather than a drug eluting one. There are plenty of options to open that stent, and if your husbands quality of life is poor, they need to offer something. If they do not, I would go to a hospital where they have greater experience in stenting. Scar tissue can be removed with laser and radiation can be used to stop the scar tissue reforming.
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