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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What does my lab report indicate?

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 2381 Questions

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Posted on Sat, 9 Jun 2018 in Hypertension and Heart Disease
Question: my question is for Cardiologist. I want stent removal (coronary) of my mother through Angioplasty. Her OCT report I'm attaching here. This stent was placed 1 month before only. This stent removal is urgent as she is having history of pott spine surgery (done in 2011) and currently MRI is to be done to find out the reason of pain. pls guide me.
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Answered by Dr. Ilir Sharka 21 minutes later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome on HCM!

I understand your concern and would explain that when considering MRI in the presence of coronary stents there have been some misinterpretation regarding the safety of the procedure.

First, I would like to explain that stents material is not ferromagnetic and that the previous belief regarding a waiting period of at least six weeks (until the stents endothelialization is done) are not scientifically based.

I would like to assure you that MRI may be performed even a short period after coronary stents implantation if some technical protocols are respected:

MRI performed in the presence of coronary stents (whether drug-eluting or no) 1.5-Tesla/64-MHz or 3-T/128-MHz, regardless of the value of the spatial gradient magnetic field.

So relax! There is no contraindications in performing MRI for your mother.

From the other side, as MRI has possible alternatives (CT if MRI is not preferred), coronary stents are not removable once implanted. They are necessary for preventing heart attack and cardiac death.

Hope to have been helpful to you!

In case of any further uncertainties, feel free to ask me again.

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka 10 hours later
oh thank you sir, but one doctor who did OCT test for my mother suggested that the stent is of smaller size than the required and blockage due to plaque is also manimal (25-30% only); hence stent can be removed by some"twisted wire" technology where 2 wires are passed through stent (Angioplasty) and by twisting these wires stent would be shrinked and then through guide wire it would be pulled out of the artery.
My family is interested in getting rid of the stent as it was not warranted in the first place. Further, taking blood-thinners life long is also not good. so kindly tell me who can remove stent by guide wire(twisted wire).
Thankyou.
doctor
Answered by Dr. Ilir Sharka 12 hours later
Brief Answer:
No indications for stent removal and no safe techniques for doing it.

Detailed Answer:
Hello again!

I agree with you about potential adverse effects of blood thinners therapy especially during the first year after stent implantation; time when double anti-thrombotic regimen is recommended. After that period it may be switched to one anti-thrombotic regimen (with less theoretical adverse effects).

Regarding the twisted wire techniques, I would explain that it has been successfully utilized in case of fractured wires or other devices used during coronary angioplasty.

In such case it has been possible to remove those fragments in up to around 80% of patients. But, it is not considered such a safe procedure, as several complications have also occurred (coronary artery wall laceration, coronary dissection or thrombosis).

To my personal opinion and professional knowledge it would be dangerous to apply this technique for coronary stents removal, especially when it is properly deployed.

Only when a coronary stent is entrapped inside the artery during angioplasty without being possible to pass it exactly through the stenosis, the interventional cardiologist could attempt its removal with such special techniques (if he has enough expertise of the field). And, as I explained this has its own risks.

But. in your mother's case, where no stent entrapment has occurred and the coronary artery lumen is patent (through mildly narrowed), there are no indications to remove the stent.

Furthermore it would be dangerous to try such a procedure (twisted wire technique), as it may risk coronary artery dissection, laceration or thrombosis.

In addition, even in the hypothetical alternative of a stent removal, it would be necessary again to continue anti-thrombotic therapy with Aspirin (which doesn't differ from the life-long strategy in case where stent is onsite).

From the other side, I assured you that MRI procedure is not dangerous, but safe enough in stented patients.

To conclude, I would explain that in daily clinical practice, coronary stents if not entrapped during the procedure (angioplasty), are removed after that only during coronary by-pass surgery when it has been necessary to provide the necessary area for distal grafts anastomosis.

That's my professional opinion.

Hope to have been helpful to you!

I remain at your disposal for any further discussions in case it would be necessary.

Wishing you a Happy New Year!

Regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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