To stent or not to stent

My husband recently had a couple of stents inserted into his arteries. He’d been having occasional chest pain (angina) when on the treadmill. A stress test and angiogram indicated some blockage, so he was scheduled for an outpatient angioplasty (inserting and inflating a tiny balloon to widen the artery). Instead, when the procedure was underway, the doc decided to insert a couple of stents (tiny metal cages) into his arteries. He ended up staying overnight in the hospital. The stents may have been unnecessary—but nobody asked me.

In a study last year of 200 patients, all of whom had one profoundly blocked coronary artery and severe chest pain, half the patients received stents and the other half received a sham operation. Both groups received medications, such as for high blood pressure. The result: those who got the sham procedure did just as well as those who got the stents. In an editorial published in Lancet along with the study results, Dr. Rita A. Redberg, of the University of California, San Francisco, commented that stents should be used only for people who are having heart attacks. Other doctors agree. (There’s general agreement that stents can be lifesaving for patients in throes of a heart attack. In 2002, my husband had a stent implanted under this circumstance.)

Stents have long been controversial. A 2007 study of 2,300 patients with symptoms of clogged arteries showed that stents did not prevent heart attacks or deaths from heart disease. In this study, all the patients had a relatively stable form of coronary artery disease that generally progresses slowly—the situation with most Americans who receive stents. Similar studies have consistently shown that stents have no advantages over a medications-only regimen. Ditto angioplasty. (Stents generate nearly $3 billion a year in sales in the United States for Boston Scientific and Johnson & Johnson, the two companies that dominate the market. Inserting them costs from $11,00 to $41,000. Husband's bill was $105K.)

My husband is now treading without pain. Still, if/when I’m in his shoes, I’m going to say no to stenting. At least that’s my plan.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.