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Medical Forum / General / General / March 2007

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Stents and Scarring

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eleaticus - 25 Mar 2007 01:38 GMT
Having the dubious benefit of stants being emplaced inside my stents, a
little thought has been called for.

Considering stents only
===============

The insult to vessel walls that invokes the scar tissue filling of a stent
would seem to be proportional to the stretching the stent forces on the
vessel wall.

We note that a stent inflated to only 80% of whatever the standard expansion
might be in the situation expands to a circumferance Pi*.8 as great as for
full expansion.

But the stent expansion and insult cannot be considered in isiolation of the
host site's characteristics.

Considering the vessel's 'natural' diameter.
============================

Consider, though, a vessel diameter, before, clogging of one unit diameter,
and an intent to inflate to some given degree, such that the standard intent
would be to expand the walls to, say, 1.6 diameters, forcing Pi*1.6 - Pi
insult to the walls, for a net stretch of Pi*.6.

The 80% inflation of intended per first example would expand the vessel to
only 1.28 diameters but the net insult would be only Pi*.28, for a relative
.28/.6 = .47 as much insult, and perhaps a proportional reduction in
scar-engendered clogging, and retaining, perhaps, a relief of symptoms.

--
eleaticus
ee-lee-AT-i-cus
eleaticus@bellsouth.net
eleaticus - 25 Mar 2007 01:43 GMT
ie, might moderation be the best policy?

--
eleaticus
ee-lee-AT-i-cus
eleaticus@bellsouth.net
William Wagner - 25 Mar 2007 12:31 GMT
> ie, might moderation be the best policy?
>
> --
> eleaticus
> ee-lee-AT-i-cus
> eleaticus@bellsouth.net

I read some where that New Orleans is hosting a cardio conference right
now.  They plan to report on their findings on March 27.  One issue will
be dealing with stenting.  The write up sort of suggested that the
participants were having heart palpitations.   :))

Bill who can't find the URL.

Signature

S Jersey USA Zone 5 Shade  
http://www.ocutech.com/  High tech Vison aid
This article is posted under fair use rules in accordance with
Title 17 U.S.C. Section 107, and is strictly for the educational
and informative purposes. This material is distributed without profit.

William Wagner - 25 Mar 2007 12:55 GMT
In article
<not-to-here-williamwag-630569.07315625032007@sn-indi.vsrv-sjc.supernews
.net>,

> > ie, might moderation be the best policy?
> >
[quoted text clipped - 9 lines]
>
>  Bill who can't find the URL.

Found it   Note not the whole article as a premium service.

Bill

...........................................................

http://blogs.wsj.com/health/2007/03/23/wheres-your-cardiologist-we-know-t
he-big-easy/

March 23, 2007, 8:51 pm

Where¹s Your Cardiologist? We Know: The Big Easy
Posted by Ron Winslow

 "Perhaps the most-anticipated study will come out
Tuesday, when researchers present a VA-sponsored study comparing
aggressive treatment with stents against aggressive drug therapy. No
matter the outcome, the report is almost certain to fuel an ongoing
controversy over whether too many patients are getting the devices these
days. "

Signature

S Jersey USA Zone 5 Shade  
http://www.ocutech.com/  High tech Vison aid
This article is posted under fair use rules in accordance with
Title 17 U.S.C. Section 107, and is strictly for the educational
and informative purposes. This material is distributed without profit.

eleaticus - 25 Mar 2007 22:41 GMT
"William Wagner" <not-to-here-williamwag@gmail.com> wrote in message
news:not-to-here-williamwag-A78ED6.07552825032007@sn-indi.vsrv-sjc.supernews
.net...
> In article
> <not-to-here-williamwag-630569.07315625032007@sn-indi.vsrv-sjc.supernews
[quoted text clipped - 34 lines]
> controversy over whether too many patients are getting the devices these
> days. "

One wonders what in L drug they have to open 100% blocked vessels.

--
eleaticus
ee-lee-AT-i-cus
eleaticus@bellsouth.net

> --
>
[quoted text clipped - 3 lines]
> Title 17 U.S.C. Section 107, and is strictly for the educational
>  and informative purposes. This material is distributed without profit.
Andrew B. Chung, MD/PhD - 25 Mar 2007 02:43 GMT
> Having the dubious benefit of stants being emplaced inside my stents, a
> little thought has been called for.

Sad to read about your ordeal.

> Considering stents only
> ===============
>
> The insult to vessel walls that invokes the scar tissue filling of a stent
> would seem to be proportional to the stretching the stent forces on the
> vessel wall.

It is to a degree until the vessel wall is cracked.

> We note that a stent inflated to only 80% of whatever the standard expansion
> might be in the situation expands to a circumferance Pi*.8 as great as for
> full expansion.

It would simply be 0.8 as great.  The Pi divides out in the
comparison.

> But the stent expansion and insult cannot be considered in isiolation of the
> host site's characteristics.

There is also the issue that a stent that is not fully expanded is
being used in an off-label fashion with the additional increased risk
of needing lifelong clopidogrel to prevent in-stent thrombosis.

> Considering the vessel's 'natural' diameter.
> ===========================
[quoted text clipped - 8 lines]
> .28/.6 = .47 as much insult, and perhaps a proportional reduction in
> scar-engendered clogging, and retaining, perhaps, a relief of symptoms.

It is wiser to properly size up the vessel beforehand so that the
stent is as fully expanded as possible per manufacturers
recommendations while minimizing damage to the vessel.

May GOD bless you.

Prayerfully in Jesus' ever-lasting love,

Andrew <><
--
Andrew B. Chung, MD/PhD
http://EmoryCardiology.com

May HIS immortal brethren pray for our dying mortal friends and
neighbors:
http://HeartMDPhD.com/Convicts

Especially dear Bob(this one) Pastorio:
http://bobs-amanuensis.livejournal.com/4211.html
http://pics.livejournal.com/bobs_amanuensis/pic/0000z24f/g1
eleaticus - 25 Mar 2007 22:41 GMT
>> > Considering stents only
> > ===============
[quoted text clipped - 11 lines]
> It would simply be 0.8 as great.  The Pi divides out in the
> comparison.

Gee, I wish I had said that!

Oh, I did.

> > But the stent expansion and insult cannot be considered in isiolation of the
> > host site's characteristics.
>
> There is also the issue that a stent that is not fully expanded is
> being used in an off-label fashion with the additional increased risk
> of needing lifelong clopidogrel to prevent in-stent thrombosis.

So, if moderation is the best policy, select a smaller stent.

> > Considering the vessel's 'natural' diameter.
> > ===========================
[quoted text clipped - 12 lines]
> stent is as fully expanded as possible per manufacturers
> recommendations while minimizing damage to the vessel.

Like I said. Choose a smaller stent should moderation be a better policy.

A resonable post, Chung.  Thank you.

> May GOD bless you.
>
> Prayerfully in Jesus' ever-lasting love,

So which is it?   Jesus not-Christ (the Lamb) or Jesus Christ, potential
slayer of the dreaded 666 monster (known to the rational as Rome or an
emperor thereof)?

--
eleaticus
ee-lee-AT-i-cus
eleaticus@bellsouth.net
Andrew B. Chung, MD/PhD - 26 Mar 2007 00:25 GMT
> Andrew, in the Holy Spirit, boldly wrote:
>
[quoted text clipped - 30 lines]
>
> So, if moderation is the best policy, select a smaller stent.

Wiser to match with surrounding more "normal" segments.

> > > Considering the vessel's 'natural' diameter.
> > > ===========================
[quoted text clipped - 18 lines]
>
> Like I said. Choose a smaller stent should moderation be a better policy.

Wiser to "properly size up the vessel beforehand."

> A resonable post, Chung.  Thank you.

You are welcome.

Would redirect your thanks to GOD so that we will both be blessed.

> > May GOD bless you.
> >
[quoted text clipped - 3 lines]
> slayer of the dreaded 666 monster (known to the rational as Rome or an
> emperor thereof)?

LORD Jesus Christ:

"KING of kings and LORD of lords." (Revelation 19:16)

Marana tha

Prayerfully in Jesus' ever-lasting love,

Andrew <><
--
Andrew B. Chung, MD/PhD
http://EmoryCardiology.com

May HIS immortal brethren pray for our dying mortal friends and
neighbors:
http://HeartMDPhD.com/Convicts

Especially dear Bob(this one) Pastorio:
http://bobs-amanuensis.livejournal.com/4211.html
http://pics.livejournal.com/bobs_amanuensis/pic/0000z24f/g1
eleaticus - 26 Mar 2007 02:15 GMT
> > Andrew, in the Holy Spirit, boldly wrote:
> >
[quoted text clipped - 32 lines]
>
> Wiser to match with surrounding more "normal" segments.

I take that as meaning expanding until the clearance is of the same diameter
as the original vessel, and I know very well you have data for that opinion.

> > > > Considering the vessel's 'natural' diameter.
> > > > ===========================
[quoted text clipped - 20 lines]
>
> Wiser to "properly size up the vessel beforehand."

> > A resonable post, Chung.  Thank you.
>
[quoted text clipped - 9 lines]
> > slayer of the dreaded 666 monster (known to the rational as Rome or an
> > emperor thereof)?
Andrew B. Chung, MD/PhD - 26 Mar 2007 02:23 GMT
> Andrew, in the Holy Spirit, boldly wrote:
> > > Andrew, in the Holy Spirit, boldly wrote:
[quoted text clipped - 39 lines]
> I take that as meaning expanding until the clearance is of the same diameter
> as the original vessel

No.  Without using IVUS, which is not routinely used outside of
clinical research, we do not know the true diameter of the coronary
artery at the site of the occlusive lesion.

> , and I know very well you have data for that opinion.

This would be the published on-label use of DES (drug-eluting stents).

May GOD bless you.

Prayerfully in Jesus' ever-lasting love,

Andrew <><
--
Andrew B. Chung, MD/PhD
http://EmoryCardiology.com

May HIS immortal brethren pray for our dying mortal friends and
neighbors:
http://HeartMDPhD.com/Convicts

Especially dear Bob(this one) Pastorio:
http://bobs-amanuensis.livejournal.com/4211.html
http://pics.livejournal.com/bobs_amanuensis/pic/0000z24f/g1
eleaticus - 26 Mar 2007 03:47 GMT
> > Andrew, in the Holy Spirit, boldly wrote:
> > > > Andrew, in the Holy Spirit, boldly wrote:
[quoted text clipped - 47 lines]
>
> This would be the published on-label use of DES (drug-eluting stents).

Like I said, no data.

--
eleaticus
ee-lee-AT-i-cus
eleaticus@bellsouth.net
Andrew B. Chung, MD/PhD - 26 Mar 2007 03:49 GMT
> Andrew, in the Holy Spirit, boldly wrote:
> > > Andrew, in the Holy Spirit, boldly wrote:
[quoted text clipped - 56 lines]
>
> Like I said, no data.

It is common knowledge that turbulent blood flow over uneven surfaces
such as the boundaries of an improperly-sized stent would be
proatherogenic.

May GOD bless you.

Prayerfully in Jesus' ever-lasting love,

Andrew <><
--
Andrew B. Chung, MD/PhD
http://EmoryCardiology.com

May HIS immortal brethren pray for our dying mortal friends and
neighbors:
http://HeartMDPhD.com/Convicts

Especially dear Bob(this one) Pastorio:
http://bobs-amanuensis.livejournal.com/4211.html
http://pics.livejournal.com/bobs_amanuensis/pic/0000z24f/g1
Andrew B. Chung, MD/PhD - 26 Mar 2007 03:50 GMT
> Andrew, in the Holy Spirit, boldly wrote:
> > > Andrew, in the Holy Spirit, boldly wrote:
[quoted text clipped - 56 lines]
>
> Like I said, no data.

It is common knowledge that turbulent blood flow over uneven surfaces
such as the boundaries of an improperly-sized stent would be
proatherogenic.

May GOD bless you.

Prayerfully in Jesus' ever-lasting love,

Andrew <><
--
Andrew B. Chung, MD/PhD
http://EmoryCardiology.com

May HIS immortal brethren pray for our dying mortal friends and
neighbors:
http://HeartMDPhD.com/Convicts

Especially dear Bob(this one) Pastorio:
http://bobs-amanuensis.livejournal.com/4211.html
http://pics.livejournal.com/bobs_amanuensis/pic/0000z24f/g1

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