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What is the probability of reblockage after stenting?

Tuesday, 18 October 2005
Answered by: Dr. V. S. Ramchandra
Professor and Head, Department of Cardiology
Kasturba Medical College
Manipal
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Q. I am 60 years old. I had a blockage in LAD and PTCA with stent done six years ago. At present I do not have any health problems. My BP is 110/70 and the blood report is good. I weigh 61 kg. I go for a walk daily for one hour. I am taking Amlong-A half tablet, Ceruvin-A one tablet and Avas-10 mg one tablet daily. Is it necessary to continue the above medicines? Is there a chance of reblockage? What precautions do I need to take?

A.  Stents may get reblocked by scar growing into them within 6 months. However if it doesn't block by 6 months it is unlikely to create problems later. As you are 6 years away from the PTCA you need not be concerned about this problem. What you need to take care, is to prevent fresh cholesterol blocks from forming. Your BP is perfect. If you did not have high BP before you were started on Amlong-A you can decrease it to Amlong 2.5mg once daily and check BP after 2-3 weeks. If it is still like what it is now or around 120/80 you can stop the amlong also, with your doctors permission. Amlong A will not have any long term preventive (helpful) action if your BP is normal. The two things that are useful on the long run are to keep your cholesterol low and continue to take medicines that prevent blood clotting like aspirin or ceruvin-A. Your LDL cholesterol needs to be 70 mg% or less & HDL (good cholesterol) need to be more than 40 mg%. Avas 10 mg is a good drug, but you may need to increase it to 20 mg if LDL is more than 70 mg%. You also need to check every year, your fasting blood sugar and CK & AST along with your fasting lipid profile at a good lab. CK and AST are tested to see that there are no side effects from Avas. Apart from this daily exercise [45 minutes of brisk walking till you are quite short of breath or till your pulse rate reaches 130/min] is a must. The exercise program should be started after you have had a normal treadmill test. Diet is very important to prevent reblockages. If you are not a diabetic a great way to start is a morning fruit bowl instead of your regular breakfast. Put all sorts of fruit pieces in a large bowl, add some sprouted legumes of all varieties, few almonds and walnuts if possible and some nonfat milk (reinforced with skimmed nonfat milk powder)with Gur or a spoon of honey. Take chapattis made of whole wheat atta. Limit polished rice, oil and whole milk products. You seem to be of ideal weight. If you are mentally stressed and following a regular yoga program that incorporates pranayama and shavasana, it will be of tremendous help. I know you are concerned on how long you should take medicines. The problem is you have a propensity to form blocks and therefore need to take your anti-cholesterol tablet & aspirin life long. The minimum I would recommend is a combination of 10 mg avas+ 75mg of aspirin available as a single tablet daily with food at night. Of course the final goal with or without the anti-cholesterol tablet is your goal cholesterol I have mentioned earlier which are very difficult to attain without drugs. Both aspirin and atorvastatin(avas) are extremely widely used, very useful and proven to be safe drugs.

A.  Stents may get reblocked by scar growing into them within 6 months. However if it doesn't block by 6 months it is unlikely to create problems later. As you are 6 years away from the PTCA you need not be concerned about this problem. What you need to take care, is to prevent fresh cholesterol blocks from forming. Your BP is perfect. If you did not have high BP before you were started on Amlong-A you can decrease it to Amlong 2.5mg once daily and check BP after 2-3 weeks. If it is still like what it is now or around 120/80 you can stop the amlong also, with your doctors permission. Amlong A will not have any long term preventive (helpful) action if your BP is normal. The two things that are useful on the long run are to keep your cholesterol low and continue to take medicines that prevent blood clotting like aspirin or ceruvin-A. Your LDL cholesterol needs to be 70 mg% or less & HDL (good cholesterol) need to be more than 40 mg%. Avas 10 mg is a good drug, but you may need to increase it to 20 mg if LDL is more than 70 mg%. You also need to check every year, your fasting blood sugar and CK & AST along with your fasting lipid profile at a good lab. CK and AST are tested to see that there are no side effects from Avas. Apart from this daily exercise [45 minutes of brisk walking till you are quite short of breath or till your pulse rate reaches 130/min] is a must. The exercise program should be started after you have had a normal treadmill test. Diet is very important to prevent reblockages. If you are not a diabetic a great way to start is a morning fruit bowl instead of your regular breakfast. Put all sorts of fruit pieces in a large bowl, add some sprouted legumes of all varieties, few almonds and walnuts if possible and some nonfat milk (reinforced with skimmed nonfat milk powder)with Gur or a spoon of honey. Take chapattis made of whole wheat atta. Limit polished rice, oil and whole milk products. You seem to be of ideal weight. If you are mentally stressed and following a regular yoga program that incorporates pranayama and shavasana, it will be of tremendous help. I know you are concerned on how long you should take medicines. The problem is you have a propensity to form blocks and therefore need to take your anti-cholesterol tablet & aspirin life long. The minimum I would recommend is a combination of 10 mg avas+ 75mg of aspirin available as a single tablet daily with food at night. Of course the final goal with or without the anti-cholesterol tablet is your goal cholesterol I have mentioned earlier which are very difficult to attain without drugs. Both aspirin and atorvastatin(avas) are extremely widely used, very useful and proven to be safe drugs.

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