Fit & Proper: Choosing the right quality stents

The rising burden and the ever-changing landscape of cardiovascular diseases (CVDs) in the country has emphasised the need for technological advancements in treatments. Continuous and sustained R&D has led to medical breakthroughs and management of cases that were once considered inoperable. Now, we have better technologies bringing precision and accuracy in the existing treatment modalities.

One such evolution was in the case of stents. A stent is a small tube which is inserted to open a blocked artery and restore the blood flow. The decision to add a stent depends on the number of arteries blocked and other health conditions. But in all the cases where stent placement has been necessary, it had a positive impact on the patient’s life.  

There are different types of stents. Bare Metal Stents (BMS), which are mesh-like tube of metal without any coating or covering and Drug-Eluting Stents (DES), which are coated with medicine that is slowly released into the artery to treat the diseased area. Since DES slowly and continuously release the medicine into the artery, the chances of re-blockage post-procedure and repeat narrowing of the artery is considerably reduced. 

Viveka Kumar, director at Cath Lab, Max Super Speciality Hospital

There has been a lot of research to ascertain the efficacy of the different types of stents. The emphasis is to choose a stent with proven safety, ample clinical data and long-term results from trials/studies. For example, the data from the Syntax trial and Excel trial showed the equivalence of Everolimus-Eluting Stents (a specific drug eluting stent) with surgery. Today, 95 per cent of the stents that are being used in the country are DES.

Quality benchmarking is another very important parameter in the case of stents. In this regard, DES approved by USFDA are the safest, as they are backed by ample clinical evidence. Just like Hallmarked jewellery ensures the purity of gold, FDA approvals assure that the stents are of high quality. 

A stent once implanted stays in the patient’s body forever and cannot be removed. It is, thus, important for patients to enquire about stents with the lowest re-clotting rate and choose a gold standard stent which carries lowest complications post-procedure. While they rely on the physicians for the final decision, a patient should make an informed choice by:

• Checking with the cardiologist what kind of stent is being used and the reason for it

• Enquire whether the that stent is approved by a recognised authority 

• Enquiring about the potential benefits and the risks

• Understand if the stent has significant clinical evidence for long-term safety and efficiancy

• Be aware of post-stenting effects and that it does not result in complications

Regardless of the reason for the ultimate choice of stent used, cardiologists should acknowledge the dynamics and parameters which influence stent selection and take decisions for future cases. Although, the onus is always on the doctor to ensure the best treatment decision, patient collaboration and informed decision making is vital for further improved outcomes.

Next week: Do you have a sweet tooth? Five simple ways to make sweets naturally