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Can I replace my exisiting stent with one of the newer types?

General responses to selected questions from Joel Braunstein, MD, of Johns Hopkins University and Joseph Toscano, MD.

Question:

Having recently had stent placement, I wanted to know if the present stent can be removed and a new stent put in. I was told new drug-coated stents will be available in December. If I continue to have a problem, would they be available and could the present stent be removed? Thanks.

Answer:

You ask a very good question, and a question that is on the mind of many people who have recently undergone stent placements to keep their coronary arteries open. Every year, approximately 1 million people in the United States undergo coronary angioplasty with or without stent placement. Unfortunately, approximately 20-40 percent of these opened blood vessels restenose (or re-clog), and many people find themselves back in the catheterization laboratory to undergo a repeat procedure.

The current stent that you have inside your coronary artery may not be removed. While stents are initially inserted against the wall of the coronary artery, they quickly become part of that wall as wall tissue envelops it. Thus, it is impossible to remove the old stent without causing serious damage to your coronary artery.

The drug-coated stents you referred to reflect the same concept as your old stent, with one major difference: Drug-coated stents usually contain a drug that works inside the wall of the coronary artery to prevent restenosis. This drug is usually affixed to the stent through a polymer coating. While little is known about the long-term effects of these drug-coated stents, most clinical trials to date have shown extremely favorable results, with some studies showing up to 1 year restenosis rates below 5 percent of individuals enrolled. The good news, too, is that even though the stent you have will be yours for life, in the future you may be eligible to receive one of these drug-coated stents if you develop a new or recurrent blockage.

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