blocked stent question - w a r n i n g !

[moochsid]

Hi All
My wife Iza had ballooning in the right jug and a stent in left valve in Katowice end of March(I think Badger left the day we arrived).
She had three good months and then rapidly downhill.
A Doppler follow up in July in Glasgow showed good flow in the right but restrictions in the left caused by possible thrombosis / thickening of the wall at the end of the stent.
We were advised to resume Clopidogrel for another 3 months and then
another Doppler in Glasgow in October revealed a seriously impaired flow but suggested that the stenosis was placed much higher up.
So off to Katowice a week ago where the Doppler showed the stent to be open fine but that flow was down.
Dr Ludyga appeared to dismiss the relevance of stenosis higher up saying that this was very often transitory but also noted a minor reflux in the right valve. However after the following days procedure the two IRs said that the right hand side was OK and the previous angioplasty had held up OK.

However concern was shown about the stent which had been re-ballooned due to a closure (not thrombosis). Consequently she is now on 90 consecutive days of Fraxiparine injections (no Clopidogrel) until a review back in Katowice.

Is this a one off case as I have not heard of such a regime elsewhere?

Also I know that venograms are the ultimate gold standard and that Doppler scans can sometimes be misleading but has anyone else had such variable results?
Kevin

[BalsaBoy]

Good luck in Poland, Badger. I'm being treated in Edinburgh at the end of the month.

[bas]

to me the polish stent is definately a no no which has now after several reopenings and a stent in stent ruined mt right jugular making it no longer serviceable.

it ruined my life

the sad fact is that I experienced that in a proper open situation of that vein my life could be different.
my advice: find a doctor who can do his job properly without a wire mesh stent.

[Cece]

Condolences, bas.
Hopefully the warning will be of help to others.

[LR1234]

Bas, My left jugular is totally occluded (with no stent)
How have your symptoms changed since the blocking? Have you had an MRI since?
Feel free to PM to chat

L x

[bas]

every time the rh jug was open I had a better life without pain and much less spasm

closure not confirmed yet but will have check up soon

[bas]

had a doppler test earlier this week and closure of stent in rh jug confirmed.

left jug still perfectly ok. mind you the lh jug could not be opened in katowiche but was performed by dr beelen from belgium without stenting.

[drsclafani]

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

DrS

[bas]

thanks for your views DrS

technically Dr Beelen could re open the jug again for the 3rd time but the effect would be less and the intimal hyperplasia would destroy it again.

covered stent within the Polish stent was not enough in my case.

waiting for new developments

[Cece]

Have you seen this thread, bas? I wouldn't jump into this but it might be a future direction. A patient who'd had 10 failed angioplasties had a jugular vein graft. http://www.thisisms.com/forum/chronic-c ... ml#p178089