hi everyone,

I will make this short if I can. On 7-19-07 I had a stent placed in my left anterior descending artery. I had one in there already from 9 years ago, but during a heart cath the cardiologist said I was about 90% blocked around the old stent and wanted to put a stent in directly above it. I was released from the hospital the next day 7-20-07, and I felt fine. after finally getting a good nights sleep, I woke up the very next day 7-21-07 early, and feeling good.
Well I felt good for about 1 hour, and then had a big heart attack. I was transported by helicopter about 25 miles away, and was given morphine, nitro, baby aspirin, and other stuff not sure of. When I got to the hospital, I was given a heart cath again, and they found that the previous stent that was just put in, was not placed correctly. the end of the stent was collapsed, and there was space between the artery wall and the stent.
Well, I had to have open heart surgery and a single bypass done, and have been released from the hospital. Whether it be single, double, triple, quad bypass, they still open you up, and it sure isnt very comfortable.
My question to you good people is, have you ever heard of a stent clogging in 2 days, or does this kinda seem that someone didnt expand the stent fully enough. there are 2 different hospitals involved here. The one where I got the stent, and the one where I had surgery. I could really use some good advice on things to remember while recovering, and any one elses experience with a dramatically failed stent like I had.

hi everyone,

I will make this short if I can. On 7-19-07 I had a stent placed in my left anterior descending artery. I had one in there already from 9 years ago, but during a heart cath the cardiologist said I was about 90% blocked around the old stent and wanted to put a stent in directly above it. I was released from the hospital the next day 7-20-07, and I felt fine. after finally getting a good nights sleep, I woke up the very next day 7-21-07 early, and feeling good.
Well I felt good for about 1 hour, and then had a big heart attack. I was transported by helicopter about 25 miles away, and was given morphine, nitro, baby aspirin, and other stuff not sure of. When I got to the hospital, I was given a heart cath again, and they found that the previous stent that was just put in, was not placed correctly. the end of the stent was collapsed, and there was space between the artery wall and the stent.
Well, I had to have open heart surgery and a single bypass done, and have been released from the hospital. Whether it be single, double, triple, quad bypass, they still open you up, and it sure isnt very comfortable.
My question to you good people is, have you ever heard of a stent clogging in 2 days, or does this kinda seem that someone didnt expand the stent fully enough. there are 2 different hospitals involved here. The one where I got the stent, and the one where I had surgery. I could really use some good advice on things to remember while recovering, and any one elses experience with a dramatically failed stent like I had.

Hi,

Stents come in different sizes. You either have an above abnormal artery size or there was an improper size implanted.

I suggest you get a copy of the cath procedure. It will provide a description of the procedure (mine is very detailed). Gives angles of observation, size and type of stent implant. It should state in conclusion something similar to wide open lumen (inner diameter of artery) with 0% residual stenosis, and no complication.

Then get a copy of the surgery report to get a perspective for the surgery. See if there is any irregularity in stent implant based on clear view of the surgeon. If you believe there was negligence seek compensatory damages. Its a rare occurrence and a prima facie case of negligence (from what I read).

Hi Robig:

Sorry to hear about your ordeal. The STLLR study that was done on the subject of stent placement revealed that up to two-thirds of the placements were not properly or imperfectly performed. With such a huge percentage of malplacement, you wonder why we don't hear more about cases like yours. I have a feeling that many more such cases are either covered up or just blamed on factors other than the proficiency of the cardiologist doing the procedure.

The study found that the problems from improper placement arise because the stent does not completely cover the diseased surface of the artery stented which results in allowing that area to build up tissue and reclose more often.

Another problem was that the stent was not fully expanded because the doctor performing the procedure was afraid to tear the artery wall, leaving a small space between the stent and the wall of the artery, again allowing for tissue buildup and reclosure.

The way the procedure is being done in many cases under angiography alone leaves a lot of guessing room as to the proper placement of the stent. Using intravascular ultrasound (IVUS) virtually eliminates this problem. So it would be prudent for a patient contemplating an angioplasty with stent placement to ask his cardiologist beforehand whether he uses IVUS or not. Check out if they used this technology in your procedure.

Your case could very likely fall in one of the above categories. The fact that you already had an old stent in that area could have also played a role in your complication. I did read about a couple of cases where the stent reclogged within a very short period of time because supposedly the the doctor failed to prescribe anticoagulant (plavix/aspirin) following the stent placement. I hope that was not the case here.

Looking on the bright side, and with all the controversy about drug eluting stents and long-term use of plavix that goes with that, it might have been a blessing in disguise because bypass surgery has a better long-term proven record, especially in your case since you already had an earlier stent that restenosed.

Right now you should concentrate on getting well after your bypass. Research and read all you can about your condition. Join a rehab program as soon as your allowed to. Exercise, diet, proper medication along with stress reduction are your best defense to keep that artery open and to put this bad experience behind you. Good luck to you.

Thanks to both of you for some very experienced and knowledgable comments. I am, at the moment, worrying only about my recovery, and learning to live a healthier lifestyle. I havent smoked in 14 days, and I am dedicated to eating better. This is not something I wish to ever have to endure again. However, I simply cant get it out of my head that this shouldn't have happened. The stent was obviously not placed correctly. I have absolutely no desire to get legal representation on this matter, however, this was such a blatant example of negligence, I feel I have no choice. Again thanks guys for your knowledge and insight.

Leaving a gap by using too small a stent is probably the single worst thing a stneting doctor can do. That small area "behind" the stent is a place where blood is slow or even entrapped and a natural (or UNNATURAL) locus of clot formation.)
Wht I am enviosioning is your doctor trying to make one continuoues stent and placing the new one slightly INTO the old one...necessitating a smaller stent and possibly causing that "end collapse."
Good luck with your lawsuit, you deserve a large settlement.

nosa,

The STLLR study that was done on the subject of stent placement revealed that up to two-thirds of the placements were not properly or imperfectly performed. With such a huge percentage of malplacement, you wonder why we don't hear more about cases like yours. I have a feeling that many more such cases are either covered up or just blamed on factors other than the proficiency of the cardiologist doing the procedure.
Your heads up on this is very important and its is doubly important that everyone consider this before getting a stent placed for reasons other than SERIOUS pain or diablement. Stents are not for SLIGHT cases of angina, or worse for SYMPTOMLESS conditions that only come to light becasue of angiography. STENTS are NOT benign.

However, I simply cant get it out of my head that this shouldn't have happened.

Robig: Try not to let this play in your head because you will only be stressing yourself needlessly. What is done is done. Concentrate on improving the "now" and not let what you have no control over (the past) cause more damage. Stress will delay your recovery. I know how it feels because I was asking myself the same "what ifs" after my heart attack when I was recovering, I kept thinking about what if I was more vigilant about my annual check-ups and maintaining my very strict diet, exercise and cholesterol levels as I did in the years immediately after the first heart attack 20 years earlier. Even though I was still very good in following a good heart protocol, I know I could have been better. Another scenario that kept playing in my head was what if I chewed the 2 aspirins immediately after I felt the heart attack as I have read about so many times before; yet I did not do it. That really bugged me for a while and I kept wondering if it would have stopped the heart attack in progress. As you get better and feel stronger, these things will not bug you as much even though you will never forget it.

As I said in my earlier post, look at the positive outcome from this experience; I really believe that bypassing that restenosed artery probably saved you more grief in the long term than having to deal with a stent placed in an area next to a 9 year old stent. At a minimum you do not have to worry about long-term plavix use and its effects in addition to all the negative news about late-stent thrombosis.

Lenin:

Stents are not for SLIGHT cases of angina, or worse for SYMPTOMLESS conditions that only come to light becasue of angiography. STENTS are NOT benign.

Amen to that. Also, make sure the cardiologist doing the procedure is very experienced and does a lot of angioplasties and not one that just took a course or does one every once in a blue moon. Don't let them practice on you. It only takes one mistake. Don't be shy to call the hospitals where they practice and ask about their credentials. Just like in any profession, there are some really good ones and some mediocres and when it comes to your heart, you want the best you can get.

Lenin,

You are absolutely correct when you said he was trying to place the new stent slightly inside the old stent. I did not get much more info from the doctor about anything else, except that i overheard the cardiologists performing the heart cath, that what they were looking at was the most rediculous thing they had seen in a while. So I have contacted a very good law firm to handle this part, and all I have to do is get myself better. I have signed up for nutrition class, cardiac rehab classes, and a couple more I cant remember. I have not had a cigarette in 14 days, and frankly have no craving whatsoever.

Thanks gentlemen for all your replies, and Not only will I get better physically(i garuantee that), but perhaps a small tad better financially. I just hope the left side of my heart has no damage. will know more about that next week on follow-up..............rob

Rob, very sorry to hear about this mess of a stenting procedure. To be short I would go for damages for sure. This is pure negligence. A simple procedure turned in to a nightmare for you. Many that insert stents are "learning". 2 of my 5 stents were placed by a doctor (internist, 40+ years old) that was in training to be a cardiologist. I think that all cardiologist have to be internist before a cardio.

Anyway, I was having more or less of an experimental procedure in lieu of single bypass surgery. Rotational arthectomy was performed in my proximal LAD. The acorn shaped cutting head came off of the tip of the catheter. The "professor" took over and after 1.5 hours on the cath table, the device was retrieved. I remember laying there thinking about a case that I had read about where the same thing had happened and had ended in emergency bypass surgery.

All went well and 2 stents were placed. The most proximal stent restenosed in 14 months to >80% closed. I just had my 4th stent placed in an end to end "kiss me" type of arrangement in my LAD. This is the very proximal (beginning) of my LAD and the restenosed stent was replaced. One other stent in the mid LAD is 30%-40% blocked.

I felt well 2.5 months ago when this last stent was placed. Now though, I am having angina at times. I have an appointment for evaluation for minimally invasive surgery at the Cleveland Clinic in September. They also put the last stent in.

Best of health to you during your recovery :)

The acorn shaped cutting head came off of the tip of the catheter.

Oh, dear Jesus...that gave me a shiver of goosepimples.

Huck, were the stents placed in the same place on the proximal LAD that got the atherectomy? Wouldn't the plaque removal suffice?

(I have always wondered what happened to the debris abraided off by rotational atherectomy. Is it so fine that there is no danger of plugging the artery "downstream" as it narrows into the arterioles? Any ideas?)

Yes Lenin, the debris is extremely fine and is flushed into the heart muscle with water pressure. This water pressure I believe removed or helped remove the cutting head. This head spins at many thousands of rpms and you can here it buzz or hum, lol.

You are on a nitro drip and any pain is prevented. That is pain from the debris entering the myocardium (just a guess). Maybe it doesn't cause pain. They didn't mention it.

Yes the very beginning of my LAD was "honed out" and stented. They also placed another stent "through an existing stent" on further down my lad...This blew my mind. (took just a small puff).

I think the "honed out" part would have been subject to scar tissue and plaque development due to inflammation and a tad of injury (maybe) to the endolithium.

This procedure was done March 3rd, 2006 at UAB hospital, in lieu of single vessel bypass. The stent was >80% restenosed 2.5 months ago, and re stented at the CC. I am now scheduled to have this mess of 4 end to end stents bypassed.

Well, I have an appointment at the CC for a surgical evaluation.
The stent inserted at the CC is not quite right I don't think. It protrudes into my left main a bit. I pointed this out while on the cath table and asked if it would impede flow. The doc said we thought about that but took measurements and it doesn't (impede flow).

My doctor here in Alabamy says no more stents in your LAD and that we are trying to keep you away from the surgeons. I am trying my best to get to a CC surgeon, lol. They only do traditional CABG here. I am trying for the minimally invasive surgery.

Best

Huck,
I think you are a wise man to wait just a little while for a minimally invasive surgery, but I wouldn't wait too long. 4 stents in one artery is way too many! The CABG is no picnic, but dont think you could find too many cardiologists who would not want to do a CABG immediately. Please take care of yourself, and get this mess straightened out as soon as possible. My surgeon told me before he operated, that if I was his brother, he would never allow me to leave the hospital with a bunch of stents in one artery. It is simply not realistic or safe.

For me, the problem was that I was never given Plavix or aspirin after the stents.

Fran, sometimes I can scratch my head in wonderment at the incompetence of some of these doctors...no wonder they call it PRACTICING medicine.
Your cardiologist should have his licence pulled or worse, his asssets taken.

I'm so sorry the luck of the draw put you into the hands of uncaring monsters.

Fran,

Sometimes when things go bad, it is so easy to whimper and whine. And another problem is that it is so easy to forget that others have it much worse than I do. I hope everything goes well with you and my prayers are with you. Man, it is so hard to have trust in doctors, when you hear so many horror stories. Thanks to everyone for the fantastic advice. I am getting all my records from both hospitals immediately, and see if I can find some answers to this nightmare.