Wall Street Journal

October 15, 2008

Two studies on stents were recently presented at a cardiology conference. The first found that many patients are being given stents without adequate documentation of ischemia (inadequate oxygen). They are doing it based on visualization of arteries that appear blocked on X-ray, and not on documentation of ischemia as recommended in standard medicine textbooks.

The other study looked at blood flow of the arteries that surround and supply the heart muscle. When the decision to place stents was based on clear proof of decreased blood flow, there was a reduction of 35% in the number of stents placed. In the group with the greater percentage placement of stents, with no documentation of blood flow, there was an 18.4% complication rate of death, heart attack or return for repeat cardiovascular procedure. The group with fewer stents placed had a 13.2% complication rate, also a reduction of about 35%.

The placebo group was not included in this study—could there have been a reason? It would have been very embarrassing if the placebo group had even fewer deaths, heart attacks or need for more cardiovascular procedures. The studies certainly did not compare to a group of equally matched patients in an alternative medicine program—because every time the group recommended for stent placement or bypass surgery is studied with chelation therapy, 80-90% of the patients no longer need the procedure.

Additional information that I would like to see before I would contemplate recommending a stent or bypass surgery is: if an artery is blocked, is the collateral circulation sufficient to keep the muscle supplied with needed nutrients, because if the blockage occurs over a slow enough period of time, collateral circulation will come to the rescue.

Inflammation is at the core of vascular (cardiovascular) disease, and the addition of a foreign body (a stent) into the blood vessel adds to inflammation. The addition of Coumadin is an additional risk incurred with stent placement. At best, how long is a stent expected to function before replacement is necessary? Before you consider a stent, please make sure all your questions are answered and you fully understand the procedure, with its inherent risks.