One treatment we now have for many coronary heart disease patients is the stent. Questions remain about the stent, though.

1. Are stents effective in heart disease?

2. Are stents effective in heart disease long term?

3. Are stents more effective in heart disease than other treatments?

A stent is a tiny tube made of wire metal mesh. This tube is inserted into a partially blocked artery to prop it open and allow blood to flow more freely.

Surgery is not needed to insert a stent for heart disease. A stent is usually placed during angioplasty. In angioplasty without a stent, a small balloon at the tip of a catheter is inserted into an artery (usually in the groin) and inflated to force open a blocked area inside the artery. If the physician believes the balloon is insufficient, and a stent is needed, the stent is collapsed to a small diameter and put over the balloon catheter. The doctor then moves the stent and balloon up the artery to the blocked section. The balloon is inflated, and as it inflates, it makes the stent expand. The expanded stent is locked in place, and forms a supportive framework that holds the artery open. The balloon and catheter are removed.

A stent is permanent. It is intended to remain in the artery, holding it open. The expectation is that it will improve blood flow to the heart and relieve heart disease symptoms for years.

Over those years, though, are stents effective in heart disease treatment? Or do they present potential problems?

Within a few weeks of the time a stent is inserted, the artery's inner lining begins to grow over the metal surface of the tiny tube. This growth tends to block the artery again. Additional plaque may also build. When this happens, the artery closes at the same place, and heart disease symptoms return. The most notable symptom is probably chest pain.

In an effort to avoid this growth, pharmaceutical companies developed a new stent to replace the bare metal stent. The new stent is coated with drugs that release slowly. The drugs help keep the artery from closing again. In either case, the patient must take anti-clotting medications, but it is hoped that the newer stents may be effective long term.

The final question is, of course: are stents more effective in heart disease than other treatments? Many prescription medications have been developed for the treatment of coronary heart disease. Suppose a patient opted to forego the stent and rely solely on medications. What then?

A landmark study published in March 2007 showed that, after 5 years, heart disease patients who had stable angina, and were treated only with prescription medications and aspirin, did just as well as those who had a stent placed in an affected artery. They survived at the same rate. Those with stent placement had more immediate relief from angina pain, but that playing field leveled over time.

The study discovered that more than half of heart disease patients who get angioplasties - 1 million plus annually - have stable heart disease. That means they would do just as well with medications as they would with stents. The authors of the study said that as many as 85 percent of all stents placed are unnecessary. In the U.S., the cost per patient of placing unnecessary stents is between $30,000 and $40,000.

Stents are effective in heart disease treatment, but medication is just as effective in patients with stable angina.

The decision maker is usually an interventional cardiologist. An interventional cardiologist is the one who performs angiography, the most prevalent test to see if an artery is blocked. He or she will require the patient's written permission, prior to angiography, to insert a stent immediately if blockage is found. In other words, the interventional cardiologist will be the decision maker for the heart disease patient.

The patient has no opportunity to discuss the severity of the blockage or the possibility of treatment other than a stent. Unfortunately, interventional cardiologists are showing signs of reluctance to give up stents. The patient will have to make a firm decision before angiography, and withhold permission if treatment with medication is preferred.

Disclaimer: The author is not a physician, and shares this research for educational purposes only. Please ask your physician about whether stents are effective in heart disease.