To Stent or Not to Stent: Researchers Say It Depends
Dec. 22, 1999 (Baltimore) -- Use of a device called a coronary stent in
people with certain types of heart disease results in less need for additional
heart-related procedures, report two studies in the Dec. 23 issue of TheNew England Journal of Medicine. Stents are the tiny wire mesh tubes
that are threaded into blocked arteries in the heart and then expanded to
create a free-flowing passage for blood.
"As expected, coronary stents increased the
diameter of the blood vessels," says Alice Jacobs, MD, professor of
cardiology at Boston University School of Medicine, who wrote an editorial
accompanying the studies. "They also resulted in less need for repeat
procedures to restore blood flow to the heart."
Other benefits seen in these studies included
less chest pain, fewer disabling strokes, and fewer heart attacks in those who
received stents. "That's why we use stents," says Jacobs. "To
reduce the morbidity [complications] associated with some types of heart
One outcome the studies did not show was that
stents help people with heart disease live longer. Jacobs says, "I think
we're going to have to study many more patients in order to see a benefit
[where death rates are concerned] and we'll probably also have to follow them
longer, and I believe the benefit will be modest. The stent population is a
lower-risk population in general."
One study looked at more than 9,000 procedures
done to people with heart disease in Canada over a three-year period. James M.
Rankin, of Vancouver General Hospital in Canada and the study's lead author,
reports, "The large increase in the rate of coronary stenting during the
study period resulted in a significant decrease in the number of heart-related
problems such as heart attacks."
The other study compared the use of a stent
along with another procedure called balloon angioplasty in people who were
having heart attacks with the use of balloon angioplasty alone. In balloon
angioplasty, a balloon is inflated to open a blocked blood vessel in the
This study also found that after about six
months, those who received the stents had less need for additional procedures.
But according to the study's lead author, "One of the most surprising
things about our study was that stenting actually resulted in a slight
deterioration [worsening] of blood flow rather than improvement," says
Cindy Grines, MD, director of cardiac catheterization at William Beaumont
Hospital in Royal Oak, Mich.
"There was also a slight, although not
statistically significant, trend toward increased mortality [death]. As an
acute MI [heart attack] patient, I would want balloon angioplasty and reserve
the stent for a less-than-perfect result with angioplasty," she tells
Jacobs says the reduction in complications
associated with stenting makes the procedure worthwhile for the patient.
"Stents will most likely be viewed as one of the most important advances in
cardiovascular medicine in this decade," she says.
- Coronary stents are mesh tubes that help keep blocked arteries open.
- In certain heart disease patients, use of a coronary stent reduces the need
for additional procedures and decreases the incidence of chest pain, strokes,
and heart attacks.
- Studies have not yet been able to show that patients with stents live
longer, probably because these patients are healthier to begin with and have
not been studied long enough.