Stent placement brings serious risks

Dear Dr. Roach: Iama 71-year-old woman diagnosed with coronary artery disease. My latest calcium score was 801. My right coronary artery was 80% blocked, and the left artery was 25%. My cardiologist asked me to decide if I want to do angioplasty or not. I don’t have any symptoms, only shortness of breath on exertion. I also can’t breathe, as if suffocated, when wearing a mask. I can’t decide what to do. My cardiologist seemed against getting a stent, not that he said that exactly, but he stressed the risk of getting a stent.

M.C.

Answer: A cardiac stent is a device placed into an artery of the heart after it is re-opened, usually by a balloon, in a procedure called an angioplasty. Stents help reduce the risk of the artery closing off after the procedure. In people with stable coronary artery disease, opening up a blood vessel can reduce symptoms, but has not been shown, despite many studies, to reduce risk of heart attack or death.

You said you were asymptomatic, but shortness of breath is one of the major symptoms of blocked coronary arteries, which are the blood vessels that provide oxygen-rich blood to the heart muscle. It can be very difficult at times to judge whether a person’s shortness of breath is coming from blockages in the artery or not, and stress testing can help answer whether this is likely. People can have shortness of breath on exertion for many reasons, including lung problems, anemia, lack of exercise or persistent symptoms after COVID infection.

While the decision is ultimately up to you — it’s your body — it’s best if the cardiologist gives you a definite recommendation and the reasoning behind it. You can’t make an informed decision without being informed.

A stent might improve your shortness of breath, but there are risks of bleeding, infection and even heart damage from a stent placement. It’s not to be undertaken lightly.

If your cardiologist doesn’t feel that the shortness of breath you have stems from your blockages, then a stent is not likely to be helpful.

Revisit with your cardiologist to get a clear idea of the potential benefit and harm specific for your case, and bring a friend or family member to assist you.

Dear Dr. Roach: I take Antabuse to help me quit drinking. Do I need to worry about the alcohol in hand sanitizers?

L.W.

Answer: Antabuse is a medication that makes people feel very sick even if they drink small amounts of alcohol.

Hand sanitizers are made from either ethyl alcohol, which is the alcohol in alcoholic beverages, or from isopropyl or rubbing alcohol. There have been case reports of people developing a reaction to the alcohol from practicing hand hygiene, from aftershave and even from inhaling fumes after practicing hand hygiene.

According to a study during the pandemic, of 42 people on Antabuse who routinely used hand sanitizers, 20% had a reaction to the ethyl-alcohol-based sanitizer, and 10% had a reaction to isopropyl-based sanitizer. Seven percent of people had severe reactions, but the rest were mild and self-limited.

There clearly is a risk for developing symptoms. People on Antabuse with a reaction to skin sanitizers should wash their hands rather than use sanitizers.