3 ms·

This is pretty well-known phenomenon to vascular practitioners... Interventional cardiologists chronically low-ball the dangers of stents and gloss-over their

This is pretty well-known phenomenon to vascular practitioners... 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").

throwawayhhakdl 7y ago
I’m not a medical expert but your hand waving of stents feels off to me. Yes, it’s not surprising that stents can be dangerous, but the alternative is open heart surgery. Which sounds pretty damn risky too. Is the choice really that simple?
- redis_mlc 7y ago
  I've followed news about stents for decades. 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.
  - raverbashing 7y ago
    > The problem is that patients aren't told they're guinea pigs 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.
  - throwawayhhakdl 7y ago
    Ok, but Google says open heart surgery costs $324,000! Which is probably a huge variance number... My point is not that stents > open heart surgery, but rather that they’re not at all easy to compare.
- pcj-github 7y ago
  Open-heart surgery is certainly no picnic, I'm not suggesting that it is. It depends on who the patient is. If you're talking about an 82yo man with renal insufficiency, that's not exactly a person you're going to rush into surgery. But if you are a relatively healthy 67yo who smoked for a decade but not actively smoking, getting a stent is likely not your best option because your expected life expectancy is still fairly decent. The point is that many people are not getting both sides of the story because cardiologists act as both the gatekeepers and the interventionalists.
joshgel 7y ago
This isn’t really true. Stents in patients with heart attacks have a clear mortality benefit except in certain high risk situations when bypass surgery has better outcomes. 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.

throwawayhhakdl 7y ago

I’m not a medical expert but your hand waving of stents feels off to me. Yes, it’s not surprising that stents can be dangerous, but the alternative is open heart surgery. Which sounds pretty damn risky too. Is the choice really that simple?

redis_mlc 7y ago
I've followed news about stents for decades. 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.
- raverbashing 7y ago
  > The problem is that patients aren't told they're guinea pigs 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.
- throwawayhhakdl 7y ago
  Ok, but Google says open heart surgery costs $324,000! Which is probably a huge variance number... My point is not that stents > open heart surgery, but rather that they’re not at all easy to compare.
pcj-github 7y ago
Open-heart surgery is certainly no picnic, I'm not suggesting that it is. It depends on who the patient is. If you're talking about an 82yo man with renal insufficiency, that's not exactly a person you're going to rush into surgery. But if you are a relatively healthy 67yo who smoked for a decade but not actively smoking, getting a stent is likely not your best option because your expected life expectancy is still fairly decent. The point is that many people are not getting both sides of the story because cardiologists act as both the gatekeepers and the interventionalists.

joshgel 7y ago

This isn’t really true. Stents in patients with heart attacks have a clear mortality benefit except in certain high risk situations when bypass surgery has better outcomes. 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.