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How do cardiologists determine how many heart stents are necessary?

Cardiology

My pharma friends have told me that private cardiologists earn more from placing more stents. I was not informed of the number of heart stents that would be placed during the actual angioplasty procedure. How do cardiologists determine how many heart stents are necessary? How will I know that the number of heart stents my cardiologist inserts is the optimum number, instead of an excessive number?

DOCTOR’S ANSWER (1)

Contrary to what you may have heard the number of stents should be determined only by the degree and extent of any narrowing and also how the procedure unfolds.

Most cardiologists do not know the coronary anatomy before the procedure unless an angiogram has been done prior. While you maybe able to predict one stent at the minimum for the severe narrowing, this is not an exact science and one cannot predict exactly how a vessel will react during the procedure.

When angioplasty is performed, the balloon is inflated and this usually pushes the fat aside with a contained dissection or tear in the layer covering the fatty plaque.

As the stent is expanded, some of the branches may be blocked by the movement of fatty plaque. This can be left alone if the branches are too small, or occasionally needs additional stents as the situation demands.

Also, the edges of the stent placement can need further stents as the narrowing propagates, but this again cannot always be foretold. 

As for more stents, usually the charges are fixed and determined by the amount of time spent inside the lab and the complexity of the procedure and not by the amount of stents. In general if more stents are placed, it usually indicates a more complex procedure and obviously takes a much longer time.

A longer time inside the cardiac catheter laboratory has health implications for the operator, with both exposure to radiation and wearing heavy leads in a standing posture. Given a choice, most cardiologists will want to have less exposure, not more.

As to the optimal number of stents for yourself – it depends on the trust you build with your cardiologist and the belief that he will do his best for you.


Dr Nandakumar Ramasami
MBBS, MRCP, FRCP

MOUNT ELIZABETH NOVENA SPECIALIST CENTRE

38 IRRAWADDY ROAD
c
#05 - 34/35 Singapore 329563


580 views 6 Aug 2018
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