Interventional cardiologists chronically low-ball the dangers of stents and gloss-over their well-known short-term performance. Who'd a thunk that jamming a foreign body in a small artery ends up making it worse in the long-term?
Patients with coronary bypass often have a better long-term outlook, but in many cases the cardiologists simply don't refer to cardiac surgeons to line their own pockets (and admit "defeat").
Stents are quite routine and much, much, much easier to do than bypass surgery.
The problem is that outside of heart attacks, there isn’t good evidence for a mortality benefit from stents. So cardiologists are constantly searching for additional evidence that justifies stent use. And there isn’t much mortality benefit yet, but lots of other reasons why they might get used. But in those cases (like stable angina), almost no one would do bypass surgery, except for patients at very high risk of having a deadly heart attack.
So criticize indication creep but there are many clear times when stents absolutely should be used.
Is the choice really that simple?
They're about $5,000 each.
A couple times per year there is some news report similar to this story.
I have a feeling that, just like hip replacements took decades to find the right combination of materials to not disintegrate or be rejected, we're still researching what to make stents from and when to use them.
The problem is that patients aren't told they're guinea pigs, and stents aren't that reliable. Oh and doctors get to bill a fortune per operation regardless.
Regarding this particular story, rather than be outraged, we should have cardiac experts and statisticians sit down and figure out what's real and what isn't. There is valuable data in there somewhere.
Here's the thing. Every patient is a guinea pig in one way or another. Every medication has side-effects both known and unknown.
But yeah, maybe stents need to be replaced before 3 years or some better materials need to be found, and maybe they are used in situation where they're not really needed.
Still better than bypass surgery which is a very invasive surgery.
My point is not that stents > open heart surgery, but rather that they’re not at all easy to compare.