Coronary Stents and MRI's

A cardiologist just said that they've revised when they allow a patient to have an MRI post cardiac stents and that it's now 10 days. He said he didn't have any documentation and was going out of town and couldn't provide it. I'm at work and don't have much time to google. The patient has a pamplet that says six weeks, or something like that. Where's a good place to look and has anyone heard the American Heart Assoc. has revised recommendations? Thanks. :)

[dianah, ASN]

The stent vendor should have a 24-hr toll-free phone number one can call for info. Find a number on the pt's pamphlet and call; they may be able to fax something. If it was placed at your facility, get the vendor's name/name of stent/date placed, and call the Cath Lab (see if someone/a supervisor is on call) and see if they have the rep's phone number/cell phone/pager for that vendor. Good luck.

If you don't have time for all that, I'll check back here and if you can provide the vendor name/number I'll call for ya.

The MRI dept often has a resource of vendors and their products, and which are MRI-safe, too. 'Course, if it's a recent change, their book may not reflect that.

[Tweety, BSN, RN]

I didn't think of that. The patient doesn't have it with him. But his wife apparently read in the pamphlet the time restriction. But funny the cardiologist who put it in would say something else and contradict the manufacturer. Hmmmm..........

[dianah, ASN]

Check this out: safe, according to this article from the Mayo Clinic, Dec. 2003

http://www.mayoclinic.org/checkup-2003/dec-mri.html

[dianah, ASN]

Another one:

Journal of Cardiovascular Magnetic Resonance

Volume 2, Issue 1, 2000

CORONARY ARTERIES

Magnetic Resonance Imaging Seems Safe in Patients with Intracoronary Stents

Page Range: 43 - 49

Anne Pauline Schroeder, Department of Cardiology; and Centre of Magnetic Resonance, Institute of Experimental Clinical Research, Aarhus University Hospital, Skejby, Aarhus, Denmark, Kim Houlind, Centre of Magnetic Resonance, Institute of Experimental Clinical Research; and Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark, Erik Morre Pedersen, Centre of Magnetic Resonance, Institute of Experimental Clinical Research; and Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Aarhus, Denmark, Leif Thuesen, Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark, Torsten Toftegaard Nielsen, Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark, Henrik Egeblad, Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark

Received March 19, 1999 ; Accepted August 25, 1999

ABSTRACT

We elucidated whether exposure to cardiac magnetic resonance imaging (MRI) of patients with implanted intracoronary stents is associated with increased risk of stent-thrombosis, stent-restenosis, or other cardiovascular complications. Forty-seven patients admitted with acute myocardial infarction (AMI) were studied. Twenty-three were included in a serial cardiac MRI study, using 1.5-T scanners with standard gradient systems. The remaining patients were control subjects who were matched for age and gender with the MRI group. All patient had intracoronary stents implanted in connection with primary angioplastic treatment (PTCA) of AMI (n = 21), secondary PTCA procedures due to recurrent angina (n = 22), or both (n = 4). In the MRI group (n = 23, aged 58 ± 10 yr), MRI was carried out one to five times in each patient a median of 166 days (range, 1-501) after stent implantation. The control group comprised 24 patients, ages 59 ± 11 yr. The incidences of stent-thrombosis, stent-restenosis, and other cardiovascular complications did not differ statistically significantly between the two groups. In the MRI group, stent-related thrombosis (n = 1) or restenosis (n = 7) was observed in eight cases a median of 102 days (range, 7-547) after MR examination and a median of 318 days (range, 138-713) after stent implantation, compared with nine cases in the control group (thrombosis, n = 1; restenosis, n = 8) observed a median of 147 days (range, 1-267) after stent implantation. No acute thromboembolic or other complication occurred in immediate connection with MRI. The follow-up time was 21.3 ± 4.5 months. This small study shows no evidence of an MRI-related risk of stent-restenosis or other cardiovascular complications, not even if cardiac MRI is performed early after stent implantation.

KEY WORDS:

Acute myocardial infarction; Coronary stents; Magnetic resonance imaging; Safety.

© Copyright 1997 - 1999, by Marcel Dekker, Inc.

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[Tweety, BSN, RN]

Dianah, thanks for much for the articles. I printed them and passed them around.

I talked with the primary who surrendered and canceled the MRI. Sounds like there is perhaps a transition period going on and the newer stents are MRI compatable sooner, but policies haven't been changed. I later found out the cardiologist said it was the AMA that is changing their recommendations, but haven't looked for any documentation.

Thanks for your input, just wondered what other institutions were doing. Most everything I've read says to wait, but as I said perhaps were in transition.

[dianah, ASN]

Tweety, it's only right to err on the side of safety when nothing is PUBLISHED for what you need. The articles, while interesting, don't really quote an official time frame for MRI, just that it's safer sooner than previously believed.

I'd want a written "OK" from the vendor, and probably that's MRI's policy too.

I did do a google search for American Heart Association guidelines or policies re: coronary stents and MRI, and didn't turn anything new up. Perhaps the ACC has something.