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Scleroderma and Stent Placement
rxjpierson posted:
I currently have a patient with scleroderma that is causing major narrowing of the arteries and vessels around the heart. The cardiologist told her the vessel was too small for stent placement anywhere from 1-1.5mm. The blockage is 90%, the doctors pretty much told her to wait for death on a daily basis. There has to be a better answer. Do they make a pediatric stent that is smaller?
Robert A Harrington, MD responded:
Interesting question. There's not a lot known about the intersection between the inflammatory diseases, like scleroderma, and coronary artery disease. Evidence would suggest that a sustained heightened inflammatory response may well contribute to the atherosclerotic process but much work remains to be done.

For your patient, there are a few other things that I would want to know. First, what are her current symptoms such as chest pain? Second, what was the reason that she underwent heart cath? For example, did she have an abnormal exercise or other imaging test? Third, where (in what artery and the location) is the 90% blockage specifically?

PCI (stents and balloon procedures) can be done on small diameter blood vessels but the risk of re-narrowing is higher than in larger blood vessels. Some of the technical approach would be based on an assessment of symptoms and how much those symptoms might be attributable to that blockage. It's always worth a second opinion. Get another cardiologist to take a look at the cath films while providing him/her the details on your patient's history etc.

Best of luck.

Bob H
bmamadia replied to Robert A Harrington, MD's response:
Can a dissolving pulmonary emboli cause fluctuating blood pressures and high mean arterial pressures as it moves through the heart?

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