• To Stent or Not to Stent: How Do Interventional Cardiologists Decide About Treatment Recommendations?


    How do you know if you need a stent? For starters, if you have a heart attack, prompt treatment with angioplasty and stenting can restore blood flow to your heart muscle and minimize damage to your heart. It’s a successful treatment backed by decades of research. But what about stable heart disease, when your life is not in immediate danger, but symptoms such as shortness of breath and chest pain (often called angina) prevent you from doing what you want in life?

    When Symptoms Affect Your Quality of Life

    If you have stable heart disease, you are probably already working with your doctor to treat your symptoms. If you aren’t, your primary care doctor may advise you to make an appointment to see a cardiologist. Treatment of stable heart disease begins with an open discussion with your doctor. Take time to record your symptoms so you can describe them accurately and thoroughly and you can describe how they are affecting your life. Let your doctor know how you want to feel and what activities you expect to be able to do after treatment. Be specific - do you want to plant vegetables, play golf or go dancing? Tell your doctor.

    Is Elective Angioplasty a Good Option?

    Before pursuing angioplasty, your doctor may recommend that you try to reduce your symptoms by making lifestyle changes first. But if adopting a heart-healthy lifestyle of eating right, not smoking, getting regular exercise and doing everything else you can to control your risk factors, including taking medication, has not given you relief from your symptoms, then it may be time to consider elective angioplasty and stenting.

    Elective angioplasty is angioplasty and possibly stenting to treat stable angina. In other words, the procedure is used to improve blood flow through a partially blocked artery for a patient who is not in immediate danger of having a heart attack. Doctors don’t always agree on the benefits of treating stable heart disease with angioplasty and stenting because the research has not been conclusive. However, with ongoing improvements in diagnostic tools, interventional cardiologists continue to gain more information about the nature and severity of blockages, which helps them make better decisions about when angioplasty and stenting are a good choice for each individual patient.

    Better Tests, Better Treatment

    Interventional cardiologists still rely on a test called an angiogram for information about the location and physical characteristics of the blockage, including how much it is blocking the flow of blood through the artery. But new technologies are giving doctors more and better information to help them decide how to treat arteries that are not entirely blocked.

    For example, a test called Fractional Flow Reserve (FFR) may now be used during an angiogram to gather information about how much the blockage is actually interfering with the flow of blood through the blood vessel. The FFR tool includes a carefully calibrated sensor that measures the blood pressure just above and below the blockage.

    If the FFR finds the difference between the two measurements is significant, then the best treatment option for that blockage is usually angioplasty and stenting. If the FFR finds that blood is getting through the blockage and the difference in pressure is not significant, then the better option may be to treat the symptoms with medications alone.

    Other Tests

    Your interventional cardiologist has other tests to choose from as well to determine the severity of the buildup and decide whether angioplasty and stenting are the best approaches. These tests include optical coherence tomography (OCT) and intravascular ultrasound (IVUS).

    Click here to learn more about other tests that are used during a diagnostic angiogram to determine the best treatment.

    Click here for more information about how your doctor chooses tests and click here for 5 recommendations to help you and your healthcare providers choose tests and procedures wisely.

    Working with Your Doctor

    It is important to remember that even the most advanced tools are only as good as the person who uses them and his or her understanding of your unique circumstances. An interventional cardiologist has experience and special training to guide you through the best treatment. You can do your part by asking questions and sharing as much as you can about how you are feeling and what you expect from treatment.

    Make an appointment with your doctor to check in and talk about your expectations for treatment, how well your current treatment is working for you, and other options that may be available to you.

    You can also click here to learn more about angioplasty and stenting and here to consider the risks and benefits.