Any experiences of having a Stent fitted in Chiang Mai.

[davehowden]

Hi all,

Does anybody have any advice about the best hospital to have a stent fitted in Chiang Mai please.

Also likely cost.

Thank you.

David

[chiang mai]

Dr Patarapong at RAM is an excellent cardiologist who I've known for over ten years, he has an excellent reputation and speaks excellent English, he's been inside my heart twice, I can highly recommend him to do a PCI.

One point to note is that the cost varies significantly between drug eluting stents and the cheaper bare metal stents. It used to be that drug eluting stents were thought to be the safer option but research has shown that using them has no impact whatsoever on mortality as long as the patient is on daily statin and aspirin therapy from day one, something that most cardiac patients are on anyway. Note: the drug coating of a drug eluting stent lasts no more than three months, after that what you're left with is a bare metal stent.

I'm not current with prices of PCI any longer, I had mine done eight years ago and my price option then were 400k for drug eluting stent, 175k for bare metal, I have a bare metal stent.

[davehowden]

Thanks for the information "Leaf Burner".

[gamini]

Dr Patarapong at RAM is an excellent cardiologist who I've known for over ten years, he has an excellent reputation and speaks excellent English, he's been inside my heart twice, I can highly recommend him to do a PCI.

One point to note is that the cost varies significantly between drug eluting stents and the cheaper bare metal stents. It used to be that drug eluting stents were thought to be the safer option but research has shown that using them has no impact whatsoever on mortality as long as the patient is on daily statin and aspirin therapy from day one, something that most cardiac patients are on anyway. Note: the drug coating of a drug eluting stent lasts no more than three months, after that what you're left with is a bare metal stent.

I'm not current with prices of PCI any longer, I had mine done eight years ago and my price option then were 400k for drug eluting stent, 175k for bare metal, I have a bare metal stent.

Your information is way out of date. New drug eluding stents are greatly improved and now much better than bare metal, also Price way too high, Siripat Hospital drug eluding stent 175 k

[chiang mai]

Dr Patarapong at RAM is an excellent cardiologist who I've known for over ten years, he has an excellent reputation and speaks excellent English, he's been inside my heart twice, I can highly recommend him to do a PCI.

One point to note is that the cost varies significantly between drug eluting stents and the cheaper bare metal stents. It used to be that drug eluting stents were thought to be the safer option but research has shown that using them has no impact whatsoever on mortality as long as the patient is on daily statin and aspirin therapy from day one, something that most cardiac patients are on anyway. Note: the drug coating of a drug eluting stent lasts no more than three months, after that what you're left with is a bare metal stent.

I'm not current with prices of PCI any longer, I had mine done eight years ago and my price option then were 400k for drug eluting stent, 175k for bare metal, I have a bare metal stent.

Your information is way out of date. New drug eluding stents are greatly improved and now much better than bare metal, also Price way too high, Siripat Hospital drug eluding stent 175 k

Studies have shown there's no difference in the mortality rates between drug eluting stents and bare metal stents, how can that possibly be out of date!!! The following article confirms no difference in mortality rates, restenosis rates are higher with bare metal stents although that rate is lowered using dual platelet therapy,aspirin and statins.

http://www.aafp.org/afp/2009/1201/p1245.html

http://citoday.com/2011/02/the-current-role-of-bare-metal-stents/

Edited June 8, 2016 by chiang mai

[tandor]

Dr Supachai at Lanna Hospital did two great jobs for me...one via right femoral, three via left wrist artery.

[Jeffrey346]

I had a drug eluting stent put in 10 months ago here in Khon Kaen.. The cost was B175,000. Fortunately, I was covered at 100% by the Thai Government Employee plan.

I was told that the medicated stent emits meds for 6 months max and is what most cardiologists recommend. I didn't request it, when I woke up I was told what was done.

[Jeffrey346]

I should have added above...

A Medicated Stent is coated with medicine that decreases scar formation on the Stent, which decreases the risk of the artery re-narrowing after Stent placement (called Restenosis).

It's true, it does not increase mortality, but it can give you a much better long term experience.

[chiang mai]

I have read that studies have shown that in patients who are asymptomatic, dual platelet therapy is just as effective as stenting. Metal stents cannot be removed without invasive surgery and there is new stent technology on the horizon that involves stents made from corn starch which will dissolve over time and I feel this is a much better solution.

But on the subject of BMS vs DES: the key in either solution is that blood platelets are made less sticky and cholesterol levels reduced, whether that is accomplished bu thinning using the coating on the stent and then later orally, versus orally from the outset, seems to me to be horses for course although the cost of DES is far higher.

[prakhonchai nick]

I have recently received stent treatment in Bangkok.

Initially you have an angiogram, which is a catherter inserted in an artery, which seeks out the cause of the problem and location. I had 2 blockages and required 2 stents. Subsequently 2 drug eluting stents were fitted.

I have not the knowledge to argue whether a drug eluting stent is better than a metal one, and like most folk would leave it to the Doctor to advise and decide.

My initial ball park figure for an angiogram and angioplasty with 1 drug eluting stent and 2 nights in hospital was 274,000bt, with a likely extra charge of around 70,000 for each extra stent.

Upon discharge I was pleasantly surprised to find the whole procedure had cost 256,000baht

Going forward there is the necessity to take Co-Plavix 75/75 tablets for the next year. I have been unable to find these available at any pharmacy, and at over 100bt/tablet/day from the hospital, this will very quickly add up. Does anyone know of a cheaper supplier?

[akentryan]

Slightly off topic but I think noteworthy. In 2014 I was told by my cardiologist at "the" hospital in Pattaya that I had blockages and needed two stents. I opted to have it done in the USA where my insurance covers 100%. My cardiologist in the USA said "You don't need stents, we can treat this by changing your medicine." Accomplished without stents and I'm still here - knock on wood.

[bprinceuk]

I had a drug eluting stent put in 10 months ago here in Khon Kaen.. The cost was B175,000. Fortunately, I was covered at 100% by the Thai Government Employee plan.

I was told that the medicated stent emits meds for 6 months max and is what most cardiologists recommend. I didn't request it, when I woke up I was told what was done.

which Hospital in KK, good info to have.

Thanks Jeffrey

[chiang mai]

I have recently received stent treatment in Bangkok.

Initially you have an angiogram, which is a catherter inserted in an artery, which seeks out the cause of the problem and location. I had 2 blockages and required 2 stents. Subsequently 2 drug eluting stents were fitted.

I have not the knowledge to argue whether a drug eluting stent is better than a metal one, and like most folk would leave it to the Doctor to advise and decide.

My initial ball park figure for an angiogram and angioplasty with 1 drug eluting stent and 2 nights in hospital was 274,000bt, with a likely extra charge of around 70,000 for each extra stent.

Upon discharge I was pleasantly surprised to find the whole procedure had cost 256,000baht

Going forward there is the necessity to take Co-Plavix 75/75 tablets for the next year. I have been unable to find these available at any pharmacy, and at over 100bt/tablet/day from the hospital, this will very quickly add up. Does anyone know of a cheaper supplier?

Most cardiologists I have met have recommend Plavix 75 AND baby aspirin (which is 81 mg) during the first year. Thereafter the choice was Plavix OR aspirin, at one point a few years ago it was 360mg of aspirin which has now been reduced to 81mg. My guess is that the trend away from Plavix and towards aspirin has cut into the Plavix market hence they've cobbled the competition into their own product! Given that Plavix is essentially aspirin, I believe it comes from the same family of drugs and aspirin is an especially cheap, the new product sounds like a rip off, especially considering there is a downside to Plavix in that it's properties are hugely difficult to reverse if the need suddenly arises to have the blood clot, perhaps because of an accident for example. If I were you I would go back to my cardiologist and explain you don't want to take a risk with Plavix because of the anti-clotting risk and can you take aspirin instead, in the absence of any other medical reason I will be very surprised if he says no.

Finally, Plavix came off patent in 2012 so there's plenty of generics out there, I would go to a good pharmacy and ask for generic Plavix and get one from a known manufacturer, the cost will be far cheaper.

[MyFriend You]

Slightly off topic but I think noteworthy. In 2014 I was told by my cardiologist at "the" hospital in Pattaya that I had blockages and needed two stents. I opted to have it done in the USA where my insurance covers 100%. My cardiologist in the USA said "You don't need stents, we can treat this by changing your medicine." Accomplished without stents and I'm still here - knock on wood.

Not at all off topic, and very good advice, anytime someone wants to invade my chest or arteries with a foreign substance, I will always seek a 2d opinion. Thanx

[chiang mai]

Slightly off topic but I think noteworthy. In 2014 I was told by my cardiologist at "the" hospital in Pattaya that I had blockages and needed two stents. I opted to have it done in the USA where my insurance covers 100%. My cardiologist in the USA said "You don't need stents, we can treat this by changing your medicine." Accomplished without stents and I'm still here - knock on wood.

Not at all off topic, and very good advice, anytime someone wants to invade my chest or arteries with a foreign substance, I will always seek a 2d opinion. Thanx

As stated early, dual anti-platlet therapy is just as effective as stenting in patients that are asymptomatic (do not experience pain), cardiac stenting is a useful technique but it has become a cash cow to the cardiologists and the stent manufacturers, hence why we are now seeing a slight fall in the cost of the procedure.

[gamini]

I have recently received stent treatment in Bangkok.

Initially you have an angiogram, which is a catherter inserted in an artery, which seeks out the cause of the problem and location. I had 2 blockages and required 2 stents. Subsequently 2 drug eluting stents were fitted.

I have not the knowledge to argue whether a drug eluting stent is better than a metal one, and like most folk would leave it to the Doctor to advise and decide.

My initial ball park figure for an angiogram and angioplasty with 1 drug eluting stent and 2 nights in hospital was 274,000bt, with a likely extra charge of around 70,000 for each extra stent.

Upon discharge I was pleasantly surprised to find the whole procedure had cost 256,000baht

Going forward there is the necessity to take Co-Plavix 75/75 tablets for the next year. I have been unable to find these available at any pharmacy, and at over 100bt/tablet/day from the hospital, this will very quickly add up. Does anyone know of a cheaper supplier?

plavix is the brand name and ridiculously expensive. You can buy the generic version called appolets at most large pharmacies and they are very much cheaper.

[gamini]

Dr Patarapong at RAM is an excellent cardiologist who I've known for over ten years, he has an excellent reputation and speaks excellent English, he's been inside my heart twice, I can highly recommend him to do a PCI.

One point to note is that the cost varies significantly between drug eluting stents and the cheaper bare metal stents. It used to be that drug eluting stents were thought to be the safer option but research has shown that using them has no impact whatsoever on mortality as long as the patient is on daily statin and aspirin therapy from day one, something that most cardiac patients are on anyway. Note: the drug coating of a drug eluting stent lasts no more than three months, after that what you're left with is a bare metal stent.

I'm not current with prices of PCI any longer, I had mine done eight years ago and my price option then were 400k for drug eluting stent, 175k for bare metal, I have a bare metal stent.

Your information is way out of date. New drug eluding stents are greatly improved and now much better than bare metal, also Price way too high, Siripat Hospital drug eluding stent 175 k

Studies have shown there's no difference in the mortality rates between drug eluting stents and bare metal stents, how can that possibly be out of date!!! The following article confirms no difference in mortality rates, restenosis rates are higher with bare metal stents although that rate is lowered using dual platelet therapy,aspirin and statins.

http://www.aafp.org/afp/2009/1201/p1245.html

http://citoday.com/2011/02/the-current-role-of-bare-metal-stents/

i was not reffering to mortality rates when i said drug eluding stents are better. they are much less like to cause re stenosis than bare metal ones.

[chiang mai]

Dr Patarapong at RAM is an excellent cardiologist who I've known for over ten years, he has an excellent reputation and speaks excellent English, he's been inside my heart twice, I can highly recommend him to do a PCI.

One point to note is that the cost varies significantly between drug eluting stents and the cheaper bare metal stents. It used to be that drug eluting stents were thought to be the safer option but research has shown that using them has no impact whatsoever on mortality as long as the patient is on daily statin and aspirin therapy from day one, something that most cardiac patients are on anyway. Note: the drug coating of a drug eluting stent lasts no more than three months, after that what you're left with is a bare metal stent.

I'm not current with prices of PCI any longer, I had mine done eight years ago and my price option then were 400k for drug eluting stent, 175k for bare metal, I have a bare metal stent.

Your information is way out of date. New drug eluding stents are greatly improved and now much better than bare metal, also Price way too high, Siripat Hospital drug eluding stent 175 k

Studies have shown there's no difference in the mortality rates between drug eluting stents and bare metal stents, how can that possibly be out of date!!! The following article confirms no difference in mortality rates, restenosis rates are higher with bare metal stents although that rate is lowered using dual platelet therapy,aspirin and statins.

http://www.aafp.org/afp/2009/1201/p1245.html

http://citoday.com/2011/02/the-current-role-of-bare-metal-stents/

i was not reffering to mortality rates when i said drug eluding stents are better. they are much less like to cause re stenosis than bare metal ones.

I believe the numbers show that is correct on a straight product to product comparison, unless placement of a BMS is supported by aspirin and statin therapy, in that event the rate of restenosis is broadly the same.

[wwest5829]

Heart attack, Dec. 5, 2015. RAM, two angioplasties and one stent placement. Bill was around 110k.

Put on Brilinta for year' which is running about $189 a month (plus others).

[Jeffkp]

I had one stent placement at Chiang Mai Ram. Dr. Kaset did the work and I see him every three months for follow up. I've been pleased. This was an emergency admission and spent a couple of nights in intensive care, so my cost may have been a bit higher. I paid ab out $10,000 for all.

BTW, I knew I would need angioplasty; so I contacted my US health insurer to find out what needed to be done. At no time did they tell me I would need to get pre-approval for my treatment. So when I sent the bill for reimbursement, they denied it. Be very careful.

I hope you will give me credit for not going into a rant!

[chiang mai]

Perhaps just to wrap up this aspect:The actual stent is identical in both cases, its purpose is to prevent the (potentially weakened) arterial wall from collapsing after the balloon has been inflated and squashed the plaque against the walls.

The role of Plavix and aspirin is to prevent stenosis and (restenosis), they make the blood "thinner" and the platelets less sticky, those medications do that regardless of whether taken orally, intravenously or whether they are emitted from a coated stent. That is why a Plavix and Aspirin therapy may often be preferable to stent placement because the stent in itself doesn't do anything to prevent restenosis or clotting..

[chiang mai]

Bumrungrad Bangkok, prices as follows:

Low - 340k, High - 580k, Median, 442k. Package Price - 165K. Single stent only.

https://www.bumrungrad.com/en/realcost-thailand-surgery/final-bill-estimate-surgery-cost-pricing?Pid=7243&RealCostPid=1

If the OP decides to go this route, Dr Aram Chusid comes highly recommended.

Edited June 9, 2016 by chiang mai

[mankondang]

Dr Patarapong at RAM is an excellent cardiologist who I've known for over ten years, he has an excellent reputation and speaks excellent English, he's been inside my heart twice, I can highly recommend him to do a PCI.

One point to note is that the cost varies significantly between drug eluting stents and the cheaper bare metal stents. It used to be that drug eluting stents were thought to be the safer option but research has shown that using them has no impact whatsoever on mortality as long as the patient is on daily statin and aspirin therapy from day one, something that most cardiac patients are on anyway. Note: the drug coating of a drug eluting stent lasts no more than three months, after that what you're left with is a bare metal stent.

I'm not current with prices of PCI any longer, I had mine done eight years ago and my price option then were 400k for drug eluting stent, 175k for bare metal, I have a bare metal stent.

Recommend both the doctor and hospital. Re the cost they give a very close ballpark figure after examination.

[banlampang]

I'm in Lampang, just down the road from Chiang mai. Two years ago I required a stent in my iliac artery due to peripheral artery disease. I discovered that the government hospital, Lampang Hospital, had just opened a cardiology floor with state of the art surgical suites and private rooms. I did some research through a surgeon friend and some nurses and identified Dr. Angsu Cartrungsan at Lampang Hospital. I scheduled an appointment and consulted with him. I found him knowledgeable and up to date. He performed the stent placement. The procedure required the use of two stents. I was in the hospital three days. Cost 75,000 baht. I spent 25 years in the US in cardiovascular product development. I'm familiar with steerable catheters and stents. Dr. Cartrungsan pulled off a difficult procedure by entering my right femoral art., advancing to the aorta, turning back down to enter the left iliac and punching a hole through a long established clot to allow placement of the stent. I was awake during the procedure and observed him closely. The man was cool as ice. He is now my new hero. For what its worth...

[Jeffrey346]

I had a drug eluting stent put in 10 months ago here in Khon Kaen.. The cost was B175,000. Fortunately, I was covered at 100% by the Thai Government Employee plan.

I was told that the medicated stent emits meds for 6 months max and is what most cardiologists recommend. I didn't request it, when I woke up I was told what was done.

which Hospital in KK, good info to have.

Thanks Jeffrey

Queen Sirikit Heart Center.. Rated the best in the NE

[Jeffrey346]

I have recently received stent treatment in Bangkok.

Initially you have an angiogram, which is a catherter inserted in an artery, which seeks out the cause of the problem and location. I had 2 blockages and required 2 stents. Subsequently 2 drug eluting stents were fitted.

I have not the knowledge to argue whether a drug eluting stent is better than a metal one, and like most folk would leave it to the Doctor to advise and decide.

My initial ball park figure for an angiogram and angioplasty with 1 drug eluting stent and 2 nights in hospital was 274,000bt, with a likely extra charge of around 70,000 for each extra stent.

Upon discharge I was pleasantly surprised to find the whole procedure had cost 256,000baht

Going forward there is the necessity to take Co-Plavix 75/75 tablets for the next year. I have been unable to find these available at any pharmacy, and at over 100bt/tablet/day from the hospital, this will very quickly add up. Does anyone know of a cheaper supplier?

I take Appolets plus 81 mg aspirin. It is much cheaper. Check with your doctor...

[davehowden]

Thanks very much to all who have contributed to this thread.

I had originally thought that when Nakornping hospital in CM decided after a closer inspection of the restriction that my wife would be better off on medication rather than a stent that they were simply trying to save money.

From the input above I now realise that this is probably not the case, ignorance is a terrible asset!!

[chiang mai]

Thanks very much to all who have contributed to this thread.

I had originally thought that when Nakornping hospital in CM decided after a closer inspection of the restriction that my wife would be better off on medication rather than a stent that they were simply trying to save money.

From the input above I now realise that this is probably not the case, ignorance is a terrible asset!!

If you want piece of mind that a particular solution is the right way to go, it's worthwhile getting a second opinion. I would guess from you've written that your wife has already had either an angiogram or a 64 slice exam to confirm the location and the percentage of the blockage? That being the case you might consider taking the results to another cardiologist such as Dr Patarapong at RAM and asking him what he thinks, it could be 300 baht well spent.

Good luck regardless.