This Is MS Multiple Sclerosis Community: Knowledge & Support

•Major complications following angioplasty are uncommon. However, inserting the catheter can lead to injury of the artery. The balloon also poses a risk of blood clots or tearing the artery.

One risk of metallic devices such as stents, mechanical valves and heart assist devices is that blood clots form on them. When a metal stent is placed in a diseased vessel to keep it open, it is followed by a high risk period for blood clot formation of six weeks-the time it takes for cells to grow over it

As noted, the most immediate threat of restenosis – especially after stent placement – is thrombosis.

Thrombosis is a concern. Very very small veins or veins that have been ballooned too aggressively may be more likely to thrombose. If stents are used, the risk of thrombosis is higher. Compared to arteries, jugulars are a low-flow system that is posture dependent. This may mean that thrombosis is more likely in jugulars than in arteries.

Thrombosis does not put us a risk of a stroke, because if the clot breaks lose from the jugulars, it goes downstream. It puts us at risk of pulmonary embolisms. This has happened to some TIMSers. If the clot stays intact in the jugulars, it blocks flow. It can be treated if caught early but typically these clots have hardened and are then often untreatable, resulting in loss of the vein.

IRs attempt to counter the risk of thrombosis with the use of anticoagulants, such as Lovenox, coumadin, Pradaxa, and Arixtra. Antiplatelets like Plavix and aspirin are also sometimes used. It is currently debated what role these have. There is not enough research on the use of anticoagulants in central veins such as the jugulars. Some doctors think they are unnecessary because they are not proven and the risk of thrombosis also is not proven.

I had something else to say about thrombosis and now I've forgotten it.

Thrombosis can be easily identified by doppler ultrasound. If you suspect thrombosis, especially in the early weeks post-procedure or if you have a stent, any IR or IR's technician should be capable of a quick, relatively cheap doppler ultrasound check of the vein. Reasons to suspect thrombosis would be a loss of improvements post-procedure or new pain in the area that was treated.

Thrombosis does need to be taken very seriously. It is one of the more preventable or treatable possible complications if caught early. The tragedy has been that patients, primarily Canadians, getting treated in far-flung locales can find it difficult to get proper follow-up care. Another tragedy has been the use of stents when it is not absolutely necessary. Determining if stents are absolutely necessary or not is a whole other story.