Jul 06, 2008
There are frequent questions being asked about the various treatments for coronary blockages. The appropriate treatment is dictated by the location of the blockage, the severity, the symptoms/ if any that the patient presents with and the medical condition of the patient
The options generally include medical treatment with cholesterol reduction, traditional open heart bypass, minimally invasive and robotic assisted coronary bypass. Percutaneous options for treatment include angioplasty often with stenting. A large number of people undergo stenting because of its minimally invasive benefit
Recent questions have arisen regarding the benefit of angioplasty and stenting versus medical therapy in patients who have stable and asymptomatic coronary artery disease. That is a person without angina, congestive heart failure or other acute heart symptoms.
These studies suggest that for people with asymptomatic, stable disease angioplasty and stenting does not reduce the chance of heart attack or death to any greater degree than aggressive medical therapy. So although the stents increase blood flow immediately and over a short period of time, the benefits diminish over time as the stents begin to develop blockages themselves. This raises the question should more careful consideration be given to treating more people with aggressive medical therapy instead of stents if they have no acute symptoms.
Furthermore, evidence exists that a small percentage of drug eluting stents have a propensity to occlude at a much earlier rate than "bare stents" and these occlusions may occur at periods well after stent placement. this occurs because the medication that prevents scar tissue from developing (which is why the stents theoretically are beneficial) also leaves the stents surface exposed and prevents the develoment of a protective coating that occurs with "bare stents". This leaves the stent exposed and increases the chance of stent occlusion by the body's natural clotting mechanism
So I think that its very important to have a conversation that includes all of these options including medication as the treatment strategy without stenting.