Wednesday, January 17, 2007

The best stent is still no stent - reloaded

I recently wrote an article for Track Your Plaque warning of the problems with stents and that heart disease sufferers should not consider them a quick fix for a lifetime of heart health indiscretions. While a stent still beats open heart surgery, bypasses, and death it is also still a sign of failure to beat the disease. Unless you intervene and prevent or reverse your disease, you will likely need additional procedures and the stents themselves carry new risks. Let's review them.

1. Inserting a stent, though minimally invasive, is still a surgical procedure that carries risks. You also get a boatload of radiation (remember, they are basically x-raying you during the entire procedure).

2. Bare metal stents are notorious for rapid "restenosis" (re-narrowing) requiring repeat procedures.

3. Drug Eluting Stents (DES) were hailed as a "cure" for restenosis but exhibit their own problem - clotting. Remember, it is a clot that causes most heart attacks. Even the best and brightest docs do not yet know why. Worse, they state that patients receiving DES may have to adhere to a dual anti-platelet regimen (usually Plavix and aspirin) for years, maybe forever! This carries increased bleeding risk (think bleeding ulcers and hemorraghic stroke). They even advise temporary discontinuance for dental procedures.

4. Unbelievably, stents are often used "off-label." Yeah, that means docs use them in ways that are not in compliance with manufacturer and FDA recommendations. That's right, it means they are experimenting on you and it's legal! Scary thought, hey?!

For the real heart health geeks like me who want more here are some of my sources. Warning, be prepared for cutting edge docs using medical geek-speak! But, the frank behind the scenes discussion will open your eyes to how modern medicine works. It ain't as pretty as they lead us to believe! Continuing Medical Education Program on Stents: Cutting edge medical techno-geeks get into it on video. You must sign-up as a member but it's free.

Drs Eric Topol and Rob Califf discuss the recent FDA meeting on drug-eluting stents: Another presentation.

Remember, heart procedures mean you are losing the battle and need to work harder. So unless you have admitted defeat - get moving. We can beat this thing!

Get involved and stay alive - and well,



John Townsend said...

What's your advise then for those of us who did get a stent? The same drug regimen? Are there specific symptoms we should look out for for restenosis? Can stents be removed? (Seems like once done, that's it). In a sense, succumbing to a stent is a tradeoff for solving an immediate critical problem for a shorter life (putting it bluntly). I'd be interesred in your view.

HeartHawk said...


I think you have hit the nail on the head. Although, a stented artery creates new long-term risks, they are not a death sentence. If you have a drug-eluting stent then you will likely need long-term anti-platelet therapy such as Plavix and aspirin.

I will pass on this question to Dr. Davis who is an expert on stents having done hundreds, if not thousands, in his clinical practice (yes, always as a last resort). Perhaps I can get him to do a Special Report on the subject.


Blog Directory - Blogged