Precautions for having a stent?

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

Precautions for having a stent?

Postby adamt » Tue Dec 14, 2010 9:35 am

I am soon going to have a stent for my May Thurner and i was wondering is there anything i should do/not do before / after having the May Thurner stent?
are anticoagulants essential or is 75mg Aspirin daily sufficient?

I currently take 75mg Aspirin daily but will be stopping this on the morning of the procedure


i am also going to have my IJVs re-ballooned, is it wise to ask the IR to balloon them aggressively as i restenosed after just 4 weeks

(p.s i have never had the MT treated)

thanks
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Postby AlmostClever » Tue Dec 14, 2010 4:14 pm

Adam,

You should consult with your treating surgeon as always.

He will probably tell you to continue the aspirin as normal and will put you on Coumadin (and increase the aspirin dose) after the procedure. He may keep you for 24 hrs to check your INR until it is coming up towards 2.0 or so. This may require a few subcutaneous injections.

Be prepared to fill yor prescription quickly as you will begin right away!

You should also make an appointment with your GP to get your blood work done to determine yor INR.

After a couple of weeks and a few lab visits, your GP should be able to determine your correct daily dosage based on your current diet.


I had my iliac stented last month with no problems. 1-month follow up showed no clotting but my left ijv was closed so I'm getting that treated again next week.

I noticed different leg spasms after the proceedure but I could move my lame leg better for about 5 days - that's when I figure the ijv closed up!


Good Luck with the procedure!

A/C
If you can't explain it simply, you don't understand it well enough. - Al Einstein
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Postby CureIous » Tue Dec 14, 2010 6:14 pm

Myself, I wouldn't dream of putting any kind of artificial device in the bloodstream without some kind of anti-coagulant, it's a "giving yourself every chance to succeed" kind of deal.

Hopefully if Dr. S perfects his angio technique for overcoming the resistance of the elastic recoil, stents will become less and less of a necessity for all but the most resilient cases. I know that's not germaine to your situation, just tossing it in there.

How soon are you going in?

Mark.
RRMS Dx'd 2007, first episode 2004. Bilateral stent placement, 3 on left, 1 stent on right, at Stanford August 2009. Watch my operation video: http://www.youtube.com/watch?v=cwc6QlLVtko, Virtually symptom free since, no relap
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Postby adamt » Wed Dec 15, 2010 10:32 am

thanks for the replies

Almostclever- i will be a day patient so will be watched for 8-10 hours post procedure
what is INR? will i need to request this?

After your May Thurner stenting what were you given?Anticoagulants or aspirin? which strength?


CureIous - i was under the impression that having a may thurner stent did not carry much risk duie to its location, nowhere near as risky as IJV stenting.


Does others have opinions of getting the MayThurner stented?
would you request ballooning or stenting of the illiac vein?

any oher thoughts on things i should do/not do before and after the stenting?

thanks
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Postby Cece » Wed Dec 15, 2010 10:50 am

Concerned posted a link about a month or so ago, about a conference in NY, in which Dr. Raju and/or Dr. Neglen, the MT experts from Louisiana, debated the use of stents in May Thurner syndrome with some other doc, who was maintaining that Dr. Raju's group was using stents far far more than anyone else and that it was not yet known if this was wise.

(Please consider this paraphrasing with potential inaccuracies. The post in question actually was wiped in a Saturday disappearance of posts after TIMS crashed, or I'd do a search and find it!)
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Postby concerned » Wed Dec 15, 2010 10:54 am

This was the article:
http://www.medicalnewstoday.com/articles/208110.php



Here's some other awesome news stories about how stent makers are just looking out for your health.

<shortened url>

http://www.businessweek.com/ap/financia ... UIPFO0.htm
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Postby adamt » Wed Dec 15, 2010 11:30 am

thanks cece and concerned for this information,
after reading i now feel a lot more confident and comfortable having a May thurner stent,

what are your views on post-MT stent blood thinners, anticoagulants or baby aspirin?


also, as i will be having my IJVs re-ballooned (after restenosing just 4 weeks after ballooning) do you think it would be a good idea to ask the new IR to 'aggressively balloon the IVs ?
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Postby bigfoot14 » Wed Dec 15, 2010 12:43 pm

concerned wrote:
Here's some other awesome news stories about how stent makers are just looking out for your health.

<shortened url>

http://www.businessweek.com/ap/financia ... UIPFO0.htm


Yes, it's the same everywhere .....drug reps, car dealers, weapons dealers, heavy equipment mfrs, doll makers, beer makers....you name it and there's unethical behavior to be found.....their goal is to sell stuff

I'm a bit cynical I guess.....
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Postby Cece » Wed Dec 15, 2010 2:15 pm

adamt wrote:also, as i will be having my IJVs re-ballooned (after restenosing just 4 weeks after ballooning) do you think it would be a good idea to ask the new IR to 'aggressively balloon the IVs ?

I'm not a fan of trying to get an IR to do a method he isn't already doing, it might be better going with a doc who already has some experience at the more aggressive methods? But that's not always available.

Yes if your IJVs restenosed in four weeks, and there is no clotting involved, that sounds like elastic recoil at work. If you've been following along in Dr. Sclafani's thread, perhaps the balloon failed to break the waisting as seen in the images?
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Postby adamt » Wed Dec 15, 2010 2:22 pm

Cece wrote:I'm not a fan of trying to get an IR to do a method he isn't already doing, it might be better going with a doc who already has some experience at the more aggressive methods? But that's not always available.

Yes if your IJVs restenosed in four weeks, and there is no clotting involved, that sounds like elastic recoil at work. If you've been following along in Dr. Sclafani's thread, perhaps the balloon failed to break the waisting as seen in the images?



unfortunately this new IR is the one im going for as the appointment is a lot sooner than other IR


that must of happened then as 4 weeks to restenose seems a very quick time,
what would you suggest i say to the IR regarding the IJVs?

thanks
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Postby AlmostClever » Wed Dec 15, 2010 3:20 pm

adamt wrote:thanks for the replies

Almostclever- i will be a day patient so will be watched for 8-10 hours post procedure
what is INR? will i need to request this?

After your May Thurner stenting what were you given?Anticoagulants or aspirin? which strength?



Adam,

I was kept for a day but my IR was very cautious! They put a stent in my iliac and ballooned my ijv's.

INR is the measure of yor blood's ability to clot. Normal is 1,0.
Ideal for anticoagulation is 2.0-3.0.

I was already on 325 mg Aspirin before this procedure because I was ballooned by Siskin in August.

I was given injections (Lovenox?) while my INR camew up because Coumadin takes 2-3 days to raise INR up sufficiently. I continued the injections for 2 more days at home (more damn injections!!!)

BTW call around to find out who has this! Not every pharmacy stocks it! Ask your doctor what he intends to pt you on after the procedure!!!

I was started at 5 mg per day Coumadin and increased it to 7.5 mg after the first week to achieve an INR between 2-3.

I still am taking 325 mg aspirin daily.


I oon't know how well that ballooning will solve M-T. It's a structural problem where there's direct compression of the vein by the overlying artery. (Mine looked like a pancake! it was open but flattened!)

We (my IR and me) felt that stenting would reduce the flow of blood thru a large collateral from the left to the right iliac. Whether or not this helped is unknown but at least I can rule it out of the equation for my lame leg (if it was!).

Here's an interesting paper that Nunzio posted on treating Iliac Vein CompressionSyndrome:

Iliac vein outflow obstruction in primary chronic venous disease
<shortened url>

Hope ths helps! Best of lck!

A/C
If you can't explain it simply, you don't understand it well enough. - Al Einstein
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