stents are undesirable but sometimes necessary, despite risks. I very rarely resort to stenting (1-2%) but sometimes the choices are high grade stenosis or an attempt at stenting.
i consider the following times to consider a stent:
1. two restenoses within 6 months after angioplasty of the same area
2. Prior thrombosis. There are patients who come to me who have developed thrombus after angioplasty done at another center
3. occlusive intimal hyperplasia (usually with stents in place) coming from another center. I try to reopen them and have used stents without much long term success. I would now consider a covered stent over the intimal hyperplasia
4. elastic stenosis, where angioplsty continuously results in immediate restenosis.
5. protection of the wall of a vein that has been injured during the angioplasty
None of these are common problems but can occur. I deally i would avoid stents in the jugulars as i have warned since early 2010.
if stents are placed, careful supervised anticoagulation is a must
That intimal hyperplasia is a really difficult thing to address everywhere in the body
Salvatore JA Sclafani MD
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