pelopidas wrote: drsclafani wrote:
erinc14 wrote:I've had stents over 3 years and sometimes when I yawn or move my head I get a sharp pain on the left side of my neck . not always though . is this normal ?
eric, what is normal? certainly not a stent. it would guess that you have a stent up high in the neck, possibly due to a compression stenosis in J3. Am i correct?
i recently met an MSer with such stents in both jugulars in his first procedure
could you please explain the pros (if any) and cons?
what can a patient do after such stents are already put in the jugulars?
Again, sorry for the delay in answering.
1. stents have value in creating an expansion of a stenosis that would be resistant to expansion, have a propensity to elastic recoil back into a stented shape or are compressed by extrinsic surrounding tissue and structure. They are helpful in salvaging thromboses and vein wall tears or dissections caused by angioplasty.
2. Stents have several downsides, some of which include:
They add cost to the procedure
They may be deployed improperly
they may migrate out of the target blood vessel
They can thrombose
They can develop intimal hyperplasia that can result in stenosis within the stent.
3. The first thing that a patient with stents should do is make sure that they have a clear record of:
the type of stent (self expanding, balloon expanded)
the name, model, and manufacturer serial number, plus,ideally, a barcode of that stent
The chemical composition of the stent and whether the stent is MRI compatible
The vein in which the stent in deployed and its location within that vein
The type of anticoagulation prescribed and taken, the dose and duration of anticoagulation
4. They should consult the deploying physician regarding a surveillance follow-up program. I think Ultrasound is as good as we have for the initial surveillance which looks for stent patency, thrombosis, fracture or migration and stenosis, either due to external kinking or compression of the stent or intraluminal in-stent stenosis secondary to intimal hyperplasia.
5. I cannot make a general recommendation about anticoagulation: some recommend life long anticoagulation, others short term anticoagulation. I like my patients to remain on anticoagulation until ultrasound shows a reasonably long period with absence of intimal hyperplasia or regression of intimal hyperplasia. An antiplatelet agent such as low dose aspirin is also helpful.
Generally, once stents are placed and develop reasonable endothelial coverage, it becomes unreasonable to consider extraction unless the patient quality of life is severly compromised. Some balloon expandable stents can be externally compressed by extrinsic pressure on the neck or by neck movements such as lateral rotation. These deformities may not spontaneously reform their intended shape and can kink the stent. This should be discussed with your doctor.