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To stent or not to stent: not always an easy answer

Today's Baltimore Sun delves into the debate over stents and the appropriate time to use them. From the piece:

...For heart patients with few symptoms and less than severe artery blockage, whether to use a stent is a question with no clear-cut answer, say cardiologists. In fact, these days some heart experts say the mesh metal tubes used to keep narrowed or weakened arteries propped open are overused for blockages that can be treated just as well with medicine, a healthy diet and exercise.

Stanford cardiologist Mark Hlatky, MD, has done extensive research on stents (two of his studies are described here and here) and provides insight in the article:

Stents only relieve symptoms; they don't make you live longer, Hlatky said, adding that he falls on the conservative side of the debate. The first question any physician and patient should ask is if interventions are needed at all or whether a person's symptoms could be helped with drugs alone, he said.

If an intervention is needed, the second question should be what kind: a stent or bypass surgery, he said. Bypass surgery is usually reserved for patients with more extensive heart disease and multiple severe blockages, while stents work best for patients with one or two blockages, he said.

As pointed out by the Sun, about one million stents are placed in patients in the U.S. each year.

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