Monday, July 27, 2009

DES STENT ALLERGY

DES is a very good device to help in the management of CAD. I began implanting DES ( Cypher stents ) from May 2002. By now I would have implanted a thousand of DES, of various types. I find that DES has been a great help. With DES, So few restenosis occured that it has affected the sngio case loads in many cardiac cath labs.. But that is good, good for the patient. However, we do see the occasional case of DES mishap, be it restenosis or stent thrombosis. These are rare, but does still occur, just as they do occur even with bare metal stents. The cause of DES thrombosis, especially late or very late stent thrombosis, differs from the stent thrombosis with bare metal stents .
In the 20th July issue of Circulation, Dr Cook and colleagues from Switzerland, publish their findings of a research, in to the possible mechanisms for very late stent thrombosis. They studied 54 patients, 26 patients act as controls with DES and 28 had DES implanted and very late stent thrombosis. They found that those DES and very alte stent thrombosis, tend to have negative remodelling, malapposition and also a ppredominance of oesinophilic infiltrates and also areas of allergic vasculitis over some of the stent struts. These will make us suspect that the DES has induced a delayed allergic reaction. We are however uncertain as to which component of the DES device cause the allergy. Is it the stent platform, the polymer coating, or the drug? Most of us suspect that it is likely to be the polymer coating, thereby sprouting out a whole new generations of polymerless, or absorbable polymers. We are seeing more and more of these stents coming into clinical usage, although we are not sure of their long-term results, and whether or not it will abolish late and very late stent thrombosis.
Much work is also being done on a new generation of bioabsorbable DES. The old bioabsorbable stents were vertainly not good enough. The present types of bioabsorbable DES under study, looks promising.
Be that as it may, it is important even as I close, to emphasize that DES are good for treatment of CAD. There are still problems with DES, as there are with bare metal stents. DES has helped more than it has harmed. They should no longer be any concerns for using a DES if the clinical indications are there.

2 comments:

Steven said...

DES good?.. hardly... not if you are the one who is suffering from ACS literally every day for 5.5years as a result of a DES... I am finding that Celebrex is a bit helpful (suggested by head of a cath lab at different hospital than the one mine was placed in) ... and looking for natural methods, top fish oil, herbs etc., anyting to stop this daily severe and dangerous vascular inflammation and pain. It has been a 10 of pain almost every day since the day after I had a large Cypher DES placed in my Osteum of LAD. Also thousands are all over the web complaning about significant post stent chest pain/angina with completely patent DES stents... really getting quite common. Every middle aged man I have met with a DES has the problem like mine. Older people don't complain, because the doctors tell them "it your heart", you are old and sick, or "not right in the head". There are also dozens of articles and studies on post stent pain, inflammation, allergy, especially for the DES... yet interventionists are still in (monetary) denial... Surgeons however are now speaking up for the first time about stents (especially DES) heated arguments are going on in hospitals. The DES is junk, dangerous... careful ballooning, followed by rest and the many available medicines and strict change in diet, untimately later excercise, all far preferable... and if need be, a bare metal in the most dire of proven cases. Otherwise forget the DES, until they invent something that does not first "harm" the patient... I am suffering every day, and have tried everything to no avail... some courageous interventionists are suggesting Celebrex, with increasing aspirin; next choice Prednisone (a dangerous choice, but what else to do) by some interventionists. Some articles and studies on the various "treatments" are on the web. But most interventionists are just blowing off the patients. Some other interventionists however are also suggesting antihistamines, and various immune altering drugs, but this is dangerous. Antihistamines did not help me at all... good idea though... only Celebrex helps me, and only a little bit, at 400mg per day. I am left to experiment on myself as many thousands of others are, suffering from "stent-osis"... far worse than arteriosclerosis, as there in apparently nothing you can do to cure stent-osis, not vigorous exercise, nothing, and the vessel just gets more inflammed the more you exercise or do anything. Bypass and removal of stent becomes all the more dangerous with stents in the way, having been inflammed in the vessel, etc. My advise: never, ever, ever allow any doctor to put a DES in you heart, ever...

Steven said...

Oh... by the way if any one reads my above post, and has any information about how to treat continued severe inflammed vessel post stenting (DES or bare metal) please post your story... what drug, or whatever you were able to do to help yourself. Did anyone have success with Celebrex long term... or any remedy? Let us all know... you could save some lives... including mine... Thanx ... SJG