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Recent reports show that cardiac stents, one of the most overused medical treatments that bring big business to stent manufacturers and specialists alike, are being used even in patients who are not likely to benefit from their use.

Questions have been raised recently on whether cardiac stents are being overused as an initial management strategy to treat chronic heart disease, specifically coronary artery disease. Are doctors putting their stable patients’ lives at risk when they place a cardiac stent to treat their condition when conservative management is just as effective?

What is a Cardiac Stent?

A cardiac stent is an expandable mesh tube that is placed inside a narrowed or weakened heart artery (coronary artery) to improve blood flow to the muscles of the heart.

Also called coronary stents, these tubes are usually made of metal, although some are made of fabric. Drug-eluting stents, on the other hand, are coated with some medicine that is slowly released into the coronary artery to prevent it from being blocked again.

Stents are used as scaffolds to hold the inner walls of a coronary artery open.  They are placed into the arteries during a procedure called percutaneous coronary intervention (PCI) or angioplasty, which is similar to a coronary angiogram. PCI is done to treat patients with coronary heart disease whose blood vessels to the heart muscles are blocked, to prevent these muscles from dying. 

It is often done to treat people suffering from a heart attack or to reduce chest pains (angina) related to coronary heart disease.

Although stents open blocked arteries and improve blood flow in the heart muscles, this does not cure coronary heart disease. Patients need to continue taking certain medications and to improve on some lifestyle factors to reduce their risk of suffering from a heart attack, a complication of the disease.

Risks of Stent Placement

The placement of a cardiac stent is a minimally invasive procedure that does not involve major incisions and only requires local anesthesia with mild sedation. Although it is generally considered a safe procedure, it is not entirely risk-free.

Immediate complications include bleeding, irregular heartbeats, damage to the coronary artery, infection, allergic reaction to the dye used during the procedure, and kidney damage caused by the dye. Aside from these, delayed complicationscan also occur.

In one to two percent of patients, a blood clot forms inside the stent, which can cause narrowing or complete blockage of blood flow.

Manipulation of the artery can cause injury to the inner walls of the blood vessel, leading to subsequent scar formation. This can likewise cause re-narrowing of the artery, which may require reinsertion of another stent or coronary bypass surgery. These events could lead to a heart attack or stroke if not immediately corrected.

New technologies in the development of stents have led to the creation of the drug-eluting stent, which are designed to prevent blood clot formation inside the stent. Because of its effectiveness and safety, the use of this type of stents has greatly increased in recent years.

The international market for cardiac stents is projected to exceed eight billion dollars by the year 2015.

Still, more stent designs are currently under development, including stents that can be absorbed by the body after they have done their job, and stainless steel stents coated with platinum.

Continue reading after recommendations

  • WebMD. Heart Disease Treatment With Angioplasty and Stents.
  • WebMD. Cardiac Catheterization.
  • NIH. What Are the Risks of Having a Stent? WebMD. Coronary Artery Disease. Rosembaum, L. When Is A Medical Treatment Unnecessary? The New Yorker.
  • Feder, B. Doctors Rethink Widespread Use of Heart Stents. New York Times.
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