Coronarystents have been around for the last 25 years or so and more than400,000 non-emergency coronary stenting procedures are performed eachyear in the U.S., according to the American Heart Association.
Butthere’s growing concern that stents are being widely overused inpatients with stable heart disease.
Angioplastyis a non-surgical procedure that uses a small balloon to open ablocked artery. Doctors will often insert a stent which is a smallmesh tube to keep the artery open and the blood flowing.
Eightlarge clinical trials found that the addition of stents provided noadded benefit over aggressive therapy with medication alone.
“Inthe cases where a person is stable and has stable angina, before weput in a stent, the physician should explain all of the other optionsas well. Such as medical therapy. if medical therapy improvespatients symptoms, putting in stents does not do anything more to thepatient. It does not increase survival and it doesn’t make them livelonger.”
St.Vincent cardiologist debasis Das agrees, too many stenting proceduresare being done in a non-emergency situation, but adds there aresituations where they can be a lifesaver.
“Onewould be a patient who is having an acute heart attack. When theartery is clogged by a blood clot and need to open up the artery andestablish blood flow. So there is no controversy about using a stentin that situation. It improves survival and saves lives. A similarsituation would be where you are about to have a heart attack. Wecall it unstable angina. Similarly, it has been shown to improvemortality if you stent those blocked arteries and improve bloodflow.“
Studiesshow that by reducing elective stent procedures by just one-third, itwould save the U.S. Health systems $6 to 8 billion annually.
TheAHA and the American College of Cardiology recommend aggressivetreatment with medications as the initial therapy for patients withstable angina.