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Saturday, October 21st 2006

Rethinking Stents

The New York Times has a long piece up on an out cropping of problems with drug coated stents.

[S]tent sales are falling and some doctors are rethinking their faith in the devices, driven by emerging evidence that the newest and most common type — drug-coated stents — can sometimes cause potentially fatal blood clots months or even years after they are implanted.

The Food and Drug Administration said yesterday that it would hold hearings in early December to consider whether to issue new stent safety guidelines.

The evidence indicates that overuse of stents may be leading to thousands of heart attacks and deaths each year

I looked really recently at PCI (Stents) versus CABG (Surgery).

Reading these studies I’m a little surprised considering all the buzz surrounding stenting and interventional procedures.

However, the stent figures from these studies are significantly better than when the interventional options consisted ONLY of balloon angioplasty.

[I]nterventional attempts to treat coronary artery disease are significantly younger than open heart surgery’s. The cost of these will decrease over time, and their “convience” compared to CABG will make them popular if their outcomes can come in line (which is already well on its wayt o happening) and when the cost finally start to come down.

Even dismissing the above reasons to be optimistic, which I’m sure there are very persuasive arguments which can, there is reason to be hopeful about future developments and innovations in interventional procedures. Certainly the field and efforts have come a long way fairly quickly. There is no reason not to hope or imagine that new innovations may eventually (and I mean relatively soon) allow interventional procedures to be the UNDISPUTED treatment for coronary artery disease.

The NYT article quotes some physicians and implies that there may be an overuse of stents. Could be very true, but stents have a place in treating CAD. Having never treated a patient I still have no doubt of that. I think interventional approaches to treating artery disease will continue to improve.