Drug Eluting Stents – Are They Safe?

Posted By SHL Librarian

Presented by: Alan C. Yeung, M.D.
Li Ka Shing Professor of Medicine; Director, Interventional Cardiology; Chief (Clinical), Division of Cardiovascular Medicine
Stanford University Medical Center
September 8, 2007

Lecture Overview:
Recently, stents have garnered considerable attention as questions of safety and efficacy have been discussed among medical experts as well as in the news. The goal of Dr. Yeung’s lecture was to provide information to those who already have a stent or are faced with a decision about getting a stent. This instructive and topical lecture focused on the safety of drug eluting cardiac stents in comparison to stents without drug coating known simply as bare metal stents. The drug eluting stent (DES), and the bare metal stent (BMS) are small metal mesh implants that are inserted into an artery to help keep it open. The coronary artery, only 3mm in diameter, can become clogged with cholesterol, lipids, calcium build-up, clots, and scar tissue. The stent is inserted as part of angioplasty, a procedure used to reestablish blood flow in a clogged artery. A DES is designed to impede the growth of scar tissue, the body’s injury response to the opening the artery. This proliferation of scar tissue, called restenosis, can grow through the stent, causing re-narrowing of the artery and once again interrupting blood flow, and prompting a repeat procedure.

Randomized, double-blinded trials have shown that the DES does a good job of preventing scar tissue formation and contributes to a decrease in repeat procedures, good news indeed since repeat intervention is not without risk. However, with the use of a DES there is a small risk (.2% or 2:1000 per year) of stent thrombosis where clots are formed, sometimes suddenly, a condition not yet completely understood, with the most likely culprit being the delayed healing. The risk of clot formation has to be weighed against the risk of restenosis, and according to Dr. Yeung the evidence is not so alarming to indicate a DES should not be used. However, the ongoing safety of the stent is very much aligned with the continuation of antiplatelet therapy (usually Plavix), particularly during the first year following implantation of a DES. In fact, there is a 29-30% chance of stent thrombosis if antiplatelet medication is stopped prematurely. Dr. Yeung said that compliance with antiplatelet therapy is exceptionally important even if it means delaying elective procedures (orthopedic, dental, etc.) in order to remain on the antiplatelet therapy.

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Dr. Yeung’s Stanford profile

Division of Cardiovascular Medicine

Dementia – Myths and Realities

Posted By SHL Librarian

Presented by: Simon Tan, PsyD
Adjunct Clinical Instructor of Neurology, Clinical Neuropsychologist
Stanford University Medical Center
September 27, 2007

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Lecture Overview:
Given that approximately 6%-8% of those over 65 years of age, and 33% of those over 85 years old have some symptoms of dementia, Dr. Tan’s lecture provided valuable information about this distressing condition. Dr. Tan began with a basic definition of dementia. It is the development of multiple cognitive deficits that include memory impairment and at least one other cognitive area such as speech (aphasia), recognition (agnosia), movement (apraxia), or a disturbance in executive functioning, defined as, for instance, multitasking, planning and organizing. Dr. Tan’s profession involves administering neuropsychological tests to patients, and he feels that it is important to convey information about dementia because it is difficult to understand and there are many misconceptions. At present, there are no medications to permanently stop the progression of dementia. However, the good news is there are ample services available for these individuals (see websites listed below).

The functioning and cognitive abilities that are evaluated when screening for dementia include:

  • Short term memory
  • Spatial skills
  • Sense of direction
  • Language ability
  • Comprehension
  • Executive function (planning, problem-solving, multi-tasking)

The most common MYTHS about dementia include:

  • Dementia only happens to others
  • Dementia only affects the patient, not the patient’s family
  • People with dementia behave this way because of negative prior life experiences
  • People with dementia can control this behavior and do it deliberately due to laziness, stubbornness, and lack of motivation

Some important FACTS about dementia include:

  • A person with dementia is not insane, necessarily psychotic, or learning disabled.
  • There are many different types of dementia. Although Alzheimer’s disease is the most common, it is not the only kind.
  • Patients with Parkinson’s disease and other neurological conditions may have dementia.
  • Frontal Temporal Dementia involves an impairment in the ability to plan and
  • What may seem like aggressive behavior may be an indication of fear, anger, dissatisfaction, particularly in the early stages of dementia.
  • Persons with dementia are not necessarily incompetent, particularly in the early and intermediate stages. Persons with mild dementia may be able to comprehend and make choices about their own health.

Often, some problems are overlooked in assessing a person’s well being and may be confused with dementia. There may be competing causes as to why a person develops certain symptoms, which may or may not be dementia. Here are some things to watch:

  • A fall is not always just a fall. It could be an indication of macular degeneration or poor balance.
  • People with dementia may have other disabilities including, for example, trouble walking, poor balance, and sleep problems.
  • Forgetfulness may indicate a medication interaction.
  • Sometimes persons with dementia may speak very well despite the onset of other symptoms that reveal dementia.
  • Some persons with early onset dementia try to compensate for it and hide it.
  • Persons with depression and dementia often exhibit the same symptoms including loss of interest, withdrawing, and apathy. The two conditions may occur simultaneously and be misdiagnosed.

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Movement Disorders Team at Stanford

Stanford’s “Farewell to Falls” program helping older adults prevent falls

Aging Adult Services – Stanford Hospital & Clinics