I’ve seen this phenomenon several times now: A highly-motivated Track Your Plaque participant with a stent in one artery will do all the right things–lose weight, achieve 60:60:60 in basic lipids, identify and correct hidden lipoprotein disorders, take fish oil, correct vitamin D, etc.
Follow-up heart scan shows dramatic reduction in scoring in the two arteries without stents–30% per artery. But the artery with the stent will show marked increase in scoring above and/or below the stent. (It’s impossible to tell what happens in or around the stent itself from a calcium scoring standpoint, since steel looks just like calcium on a CT heart scan.) In other words, there is marked plaque growth in the vicinity of the stent, despite the fact that dramatic reversal of atherosclerosis has occurred in other arteries without stents.
Should we take this to mean that a stent destroys the opportunity for atherosclerotic plaque reversal in the stented artery? I don’t know, but I fear this may be true. What dangers does this different sort of plaque pose? Is it the result of the injury imposed at time of stent implantation, some modification of flow or biologic responses as a result of the presence of the stent?
These are all unanswered questions. But I believe that it is yet another suggestive piece of evidence that the best stent is no stent at all.
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