Is there a risk of NOT stenting?

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Submitted by Dr T on August 5, 2011 – 7:33am

Found out my right coronary has am 80 percent blockage. My cardiologist does not want to stent it. Does that make sense?

It depends on other findings that include the results of a variety of other tests, such as a stress test. Percutaneous coronary intervention (PCI) may be indicated in patients who have:

  • Limited disease (such as yours),
  • Significant areas of cardiac ischemia (insufficient blood supply) as seen with stress tests,
  • Disabling symptoms that do not respond to medical therapy,
  • Can be life saving in some types of acute heart attacks.

The benefits of PCI need to be weighed against the risks: PCI (at a cost of approximately $20,000 to $50,00) doesn’t prolong life, protect against progression of disease or future heart attacks, and requires expensive ($2000 to $3000/year) medications to keep the stent open. Recurrences are NOT rare, and most patients will need repeat procedures in due course, exposing them to the same risks over and over again.

In contrast, many patients with coronary artery disease and “stable” symptoms often do better with “Optimal Medical Therapy” than with Stenting.

I have blogged about excessive stent usage before, because not only because stents are often overused, but also bcause there are real risks involved, not only with the procedure itself, but also later. In many circumstances  medical therapy alone is often superior to stenting. In  addition, non-cardiac surgery surgery after stenting can be quite dangerous, presumably because medications, needed to keep the stent open, have to be stopped to avoid the risk of bleeding during the procedure.

If you’d like to evaluate what the optimal treatment would be in your case, take this test.
Hope this helps,
Dr T

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