How do cardiologists decide whether or not a cardiac stent is required?

Doctor's Answer

I agree with Dr Nandakumar's comprehensive reply.

To revascularize (stent or bypass) or not can be a simple question to answer in some but a rather difficult one to answer in some others. Assuming there is no contra-indication to the procedure, if one has cardiac symptom not controlled with medications OR objective evidence of ischemia that affects at least moderate amount of heart muscle OR triple vessel disease (or left main disease), one should go for revascularization (either stenting or bypass, the choice of which depends on various factors).

Minor coronary artery disease (< 50% blockage) is treated with medical therapy only. Most of the (significant) single vessel coronary artery disease would be treated with medical therapy in the absence of symptom.

If symptom is present in these, one can choose either medical therapy or revascularization as initial approach, and proceed to revascularization when medical therapy fails. The exception being proximal LAD; most of the cardiologists would recommend stenting to be done as the amount of heart muscle at risk (supplied by the narrowed artery) is substantial.

As you do not have symptom, I would suggest that you consider bringing your coronary angiogram CD (and other reports) to another cardiologist for review, since you are not sure what to do.

In all cases, optimal medical therapies would still be needed to reduce the progression of the disease in the narrowed segment as well as the rest of the arteries.

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