Ask the Doctor: Blocked Stent in Artery; What “Hypoallergenic” Means
Q. I had a stent placed in one of my coronary arteries, and my doctor said the artery might become blocked again in the future. How will I know if that happens? If the artery closes, will the old stent be removed and replaced with a new stent?
A. A coronary artery stent is a very small, metallic tube that is inserted into a narrowed or blocked section of a blood vessel so that blood can flow freely again and deliver the oxygen the heart needs to function normally. However, a stent is not always a permanent solution.
Stents are very effective at opening up narrowed arteries. However, sometimes scar tissue forms inside the stent and impairs blood flow; this is called “in-stent restenosis.” Also, although it is rare, blood clots may form inside of stents; to prevent this, it is critical that you take anti-clotting medications exactly as your doctor has prescribed them. Medications commonly given after placement of a stent include clopidogrel (Plavix), ticagrelor (Brilinta), prasugrel (Effient), and aspirin.
The rate of restenosis has decreased since drug-eluting stents (DES) were invented; a DES is a stent that slowly releases a drug that helps prevent the growth of scar tissue and the buildup of plaque inside the artery. Under the best conditions, less than 5 percent of patients with a DES require re-intervention at one year, while about 10 percent will need another procedure within five years.
Once stents are placed, they are incorporated into blood vessel walls and cannot be removed. If restenosis occurs, treatment options include balloon angioplasty, which pushes the scar tissue against the artery walls, cutting balloon angioplasty, which can cut out scar tissue with small blades, and placing a new stent inside the previous stent. With restenosis, symptoms such as chest discomfort and shortness of breath may occur; these signs usually develop gradually, but you should report them to your cardiologist immediately so that he or she can evaluate your condition and determine if another procedure is needed. If the blockage in your artery has recurred several times or if there are multiple blockages, bypass surgery may be needed.
Following a heart-healthy diet, taking medications as prescribed, not smoking, and regular visits with your cardiologist are the best ways to reduce the likelihood of in-stent restenosis.
Q. I recently purchased a facial moisturizer that was labeled “hypoallergenic,” but my skin still broke out in a rash. Why did this happen if the product is supposed to be free of skin irritants?
A. The term “hypoallergenic” is used to market many health and beauty products, but while it seems to imply that the products are less likely to cause allergic reactions than conventional options, the U.S. Food and Drug Administration (FDA) says no scientific evidence backs up those claims. In fact, the FDA has no standards or definitions for the term—according to the agency, hypoallergenic “means whatever a particular company wants it to mean.” Research suggests that many products labeled as hypoallergenic contain at least one known skin allergen.
The best precaution you can take is to check product labels for allergens, but even that can be a challenge, since many of the chemicals included in face creams and similar products are marketed under several different names. This means that, while you may carefully check labels for certain ingredients, you may still end up buying a product containing an allergen.
When buying a face cream, choose one with the fewest ingredients—that gives you the best chance of avoiding allergens. Also select products that are fragrance-free; fragrances are one of the biggest triggers for allergic reactions. Finally, always test a new product on a small area of skin and wait 24 hours to see if there is a reaction before using it elsewhere.
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