Should I accept a stent?

[bizzy55]

I might be offered a stent after my angiogram tomorrow. Upon reading this article I'm not sure if I should go for it :

nih.gov/news-events/news-re...

[fedupoffeelingtired]

wouldn't be alive today if I hadn't had my stent. Meds alone wouldn't have saved me I had a 90% Blockage as a result of genetics. Consultants don't do the procedure as a matter of course. If you don't need it they won't do it and meds may be the best way forward for you. They normally do the stent whilst doing the angiogram if a blockage is found. Speak to the consultants about any concerns you have, they will have more reliable information than a random article

[Fair1 in reply to fedupoffeelingtired]

high bizzy

You ask the question to have a stent or not in my experience back in April 2021 it’s the only thing that kept me alive 3/4 of my hart and left lung was so badly damaged due to major blood clots the stent was the only thing which allowed a good blood supply nearly nine months later they put a further seven stents in me and my hart as started to repair the blown valves in my hart I will never be the action man I was once but now spending the rest of my life supporting my family emotionally and physically through there times is my job so go for the stents it’s a little uncomfortable but it’s worth it and be kind to yourself the meds can trigger a lot of emotions and some days feel like climbing Mount Everest haha but it’s worth it good look and stay positive

[Hidden]

Hello

Obviously this is your choice and yours alone

If you have any concerns talk to the Consultants get their point of view on what you have read

I had 3 heart attacks and was not till after the third did I have an angiogram which showed I needed a triple Bypass I did not have to think twice about saying yes

Had I been offered stents I would have said yes to and in a way deep down I knew I needed something and was hoping it would be stents rather than Bypasses

So I would say yes I would accept a stent if offered

Let us know how you get on x

[Becdan]

I am so glad that I had a stent fitted when I was having a heart attack. It was such a relief to feel loads better almost straight away after having the stent fitted and I would definitely do it again if the need arose but hopefully it won't.

I dread to think how it would have turned out for.me if stenting wasn't available as I had a blocked artery but can't remember to what degree.

[Chappychap]

Of course you should accept a stent. You should accept whatever your doctor recommends. Doctors may not be all-seeing gurus, but they're a lot more qualified and experienced than any of us, and disregarding their advice rarely ends well.

The big mistake however is to think that a stent, on its own, will fix your heart problems.

Stents can alleviate the symptoms of angina, and when fitted during the course of a heart attack stents can save your life. Indeed stents are the single biggest explanation for the turn around in heart attack survival rates between the 1960's and today. Back in the 60's most people died of their heart attacks, today most people survive.

But in terms of reducing our risk of future heart attacks or strokes, the only two things that make any meaningful difference are medication and life style changes. That's why the NHS invests in Cardio Rehab training, which is basically education and motivation for us to all to fully embrace medication and life style changes.

I've not seen any meaningful evidence that stents (or indeed bypass surgery) delivers a significant reduction in the risk of a future heart attack or stroke, but I've seen masses of evidence that medication and life style changes can make a huge reduction in those risks.

So, if your doctor offers a stent then accept, but in addition resolve to fully implement all the recommended medication and life style changes.

Good luck!

[bizzy55]

Thanks for all the replies.

Just to add some background, my only issue so far has been fairly mild angina symptoms. A burning sensation when walking. I found that the symptoms passed after I had stopped a few times and took deep breaths. Now on angina and blood pressure meds and the symptoms have gone. So I was wondering if I will need a stent at all. I guess I shall leave it to the experts.

[ChoochSiesta in reply to bizzy55]

I had those similar symptoms to you. I also thought that there wasn't much wrong. Doctors recommended and did a triple bypass which they described as urgent.

[JennyRx in reply to bizzy55]

I had similar symptoms- breathlessness on exercise, could be quite severe at times esp during my runs but very little pain. I had a 100% blocked RCA and had two stents fitted. I’m now running more than I did before and also now swimming. These two activities will help make me healthier plus my meds, but the stents have made it possible to do those activities. I rarely get breathless now. It was a no brainer for me. The stents bought me a level of health that I can continue to build on through exercise as well as diet and meds

[WardijaWardija in reply to bizzy55]

Dont wait for it to get worse and potentially fatal. If your consultant says you need it, you need it . . The NHS is not in a position to waste resources on interventions that patients dont need.I was told that ideally that I needed a quadruple bypass, however, due to a prior stroke and other medical issues, I was told a bypass was not an option as " I would most likely die on the operating table . . "

Stents were my only option.

I had 3 stents (all done in one procedure), with this and lifelong medication, I'm totally symptom free and have never looked back, and that was 3 years ago.

[Letsallhope1 in reply to bizzy55]

you’ve got to discuss your doubts with the consultant who will explain the reasoning behind the decision of putting you through a surgery.

I believe that very often articles are misleading and I would not base my decision upon reading the article you added on here.

Heart surgeries carry a risk and cost a lot of money, therefore, if your consultant think you need a stent, I would at least listen to his reasons for the decision. As many said on here, ultimately the decision is yours, but at least give yourself the chance to talk to the professional about it.

Good luck!

[Hidden]

research, articles etc are always useful but have to be read and understood in their entirety. My understanding is it is saying that where patients are symptomatic they get most improvement in symptoms from invasive procedures. Those that are not symptomatic May not see any greater benefits over conservative treatment I.e. meds / have counselling / lifestyle changes are appropriate rather than invasive. But also says needs more monitoring / research. It’s your decision, I’m always personally minded to heed what a trained cardiologist recommends (as long as feels logical to me and they have explained all benefits and risks) is best in terms in treatment (until such time it does not help and so back I trot). Keeping an open mind and talking through the pros and cons with the cardiologist may help you come to a conclusion. Good luck.

[Heather1957]

As someone has already said ultimately it is your decision.

Personally I would rather this than have to be blue lighted to the hospital with a heart attack and if I survived HAVE to have a stent (if you are lucky) or a by pass.

Maybe you should weigh up the pros and cons.

[Milkfairy Heart Star]

You have had some good advice.

Stents can certainly be life saving in certain instances such as a ST elevation myocardial Infarction STEMI, when the artery is nearly completely blocked.

However if you have stable chronic angina the evidence suggests that optimal medication may be just as affective.

"The ORBITA trial showed that among patients with stable angina, PCI does not result in greater improvements in exercise times or anginal frequency compared with a sham procedure, despite the presence of anatomically and functionally significant stenoses."

acc.org/latest-in-cardiolog...

Angina can also be due to Non obstructive coronary artery disease, microvascular and vasospastic angina.

The only treatment option in this case is by medication.

You should before you sign your consent form discuss with the Cardiologist the possible benefits and risks of the angiogram and treatment options.

Including the option of medication versus stents.

Good luck for your procedure.

[Cruiser25]

As someone who did need the emergency stenting during a full blown Stemi HA, I can definitely say, if it's recommended and available then have it.

I lost a third of my heart function in the time it took to open up my artery, that's with Paramedics getting to me in 15 minutes, immediate gtn spray and aspirin upon arival, stabilising me & and blue lighting me to the specialist cardiac unit, the team waiting- literally ready to stent as I got onto the table. All this from 999 call to stent in less than 90 mins! Not everyone will have been as lucky as me!

As the others have very plainly said, meds and lifestyle changes are crucial, please don't delay if this is required, I really wouldn't recommend the elephant sitting on your chest, and gasping for breath, not a pleasant feeling, and one you don't ever forget.

Please take care of you.

[Mentdent]

In the USA there is a considerable problem with over testing and over prescribing. This has been particularly obvious with prescription painkillers and cardiac stents. This is what prompted this study. In places like the UK you’ll get a stent because you need one not because there’s a fee for it.

[alfraser in reply to Mentdent]

100% agree with this. NIH is a US body, so be mindful about how you consider the basis of any papers. I have lived in and used the medical system in both the UK and the US, and I have worked in and around the medical insurance sector. The US spends way more per capita (fact - would need to get you a citation), and has a tendency to reach for intervention faster (my opinion based on experience). Neither of these things is intrinsically better or worse without more evidence about the particular area under consideration, but I would be extremely cautious about reading US research and drawing conclusions about UK healthcare provision.

I had a heart attack in my early 40s and an angiogram two days later and was advised that they would not recommend a stent. I would 100% go with what the doctor recommends. Bad symptoms may not have underlying endemic causes (my case), but if they find that the symptoms you find to be mild have dangerous causes I would recommend you to go with their advice.

[bikerider2022]

Talk to your consultant if you have questions. I’ve got a stent and it’s been fine, I’m also on a cocktail of meds for AF etc. talking and asking questions is a powerful tool to understanding what’s going on

[Heartsofoak]

I ended up having 12 stents between 1998 and 2020 and wouldn't be here if it wasn't for them. Take the cardiologists advice, they know what they are doing.

[leach234]

However, such procedures offer better symptom relief and quality of life for some patients with chest pain, according to two new, milestone studies.

Is that you?

[JennyRx]

To clarify, there’s a difference between stenting due to STEMIs and as a treatment for angina/blocked arteries. There appears to be some evidence that they don’t act as a preventer of HAs on their own in patients who haven’t had such an episode - that’s achieved through meds and lifestyle but once you’re in that HA situation different decisions are made. But they can give a better quality of life to angina patients.

[RJBme]

Definitely go for it, I have had 6 x stents fitted over the years and would doubtless not be alive now if I hadn't.

[pasigal]

Here's my experience: no chest pain or other symptoms, but 90% LAD blockage. Healthy, but family history of CAD, including lipoprotein A marker.

Have 2 stents inserted. 8 months later, have cardiac arrest, barely survive. Apparently, plaque ruptured in my circumflex artery. 2 more stents inserted, still never had chest pain. I'm on the usual cockatail of meds, 18 months later I'm slowly getting back to a decent quality of life. I've read that survey up, down and backwards, and talked to a few cardiologist acquaintances, who say that in my initial case, with 90% LAD blockage, they'd ALL opt for stenting.

Now, my brother also has CAD, but his LAD blockage is around 50%; he's never had any symptoms. He is on high doses of statins.

My suspicion is that the original stenting caused something to change in my cardiac circulation for the worse, and that's why I later had the cardiac arrest. I can't prove it; it could have been totally unrelated but I doubt it.

I think I just had bad luck -- I do see the need for stents if symptoms are particularly bad; you're having an actual infarctus, or a key artery like the LAD is nearly or fully blocked. But other than that, probably not. I guarantee that every interventional cardiologist has read those studies, too...

[Chrissca71]

i had an angiogram in June and three stents fitted, i had not had a heart attack and the stents came as a complete surprise as they had found my artery was blocked hence the angina now almost 7 months later i am so glad this was done as it was a wake up call to change my life style

[The_Voice]

Did you read the entire article? It clearly states at the end that their recommendations are based on whether the patient does or does not have symptoms. If you’re going for a angiogram, it’s safe to assume that you’re experiencing symptoms significant enough to warrant an evasive process - that could potentially save your life.

The doctor will tell you after the angiogram whether or not you need stenting - they generally only recommend it if there is a significant blockage, and if it’s at that point already, you seriously need to consider it. If it’s not bad enough, you’ll go on medication and lifestyle changes.

I had a stent fitted into my LAD after 4 MIs - it was 99% blocked. They didn’t see any other significant blockages at the time, so off I went into rehab with my new meds. Almost 4 years later, and multiple trips to the A&E with unstable angina, I was eventually granted an angiogram where they found a > 50% blockage in OM1. Needless to say, they don’t recommend stents willy-nilly, so I jumped at the chance.

[Harefieldfan]

I had no symptoms at all when I had my heart attack. No pain. I just felt I had to sit down and then I fainted. Echocardiogram showed two severely blocked arteries— one so blocked they had to drill the calcium out. I now have two stents. Still no pain but after recovery and a spell of feeling exhausted all the time, I can now walk up hills. It’s your choice of course but if I were you, I’d go for the stents. Good luck!

[Genesini]

Your choice of course, but if a stent IS suggested, then the cardiologist has decided that is your best long term prognosis. They wouldn't suggest one unless you absoloutely needed one. I had a stent, drugs would not have saved me, but I was having a major heart attack at the time. Trust their superior judgement, then make your decision based on how your symptoms affect your every day life. Good luck and Happy New Year.

[TCX57]

hi bizzy

I had three stents fitted and touchwood have had no problems. I Think that you have to be guided by the expert advice of your consultants in relation to this issue.

I wish you all the best whatever you decide to do. All the best Tony

[Andyman]

I'd be dead now without my stents.

[tizz1]

Go for it ive had 5 stents and never felt better

[Hearthrob]

it seems that the article has answered the question:

"He cautioned patients in the meantime to confer with their doctors to determine what strategies are best for them"

[Flimflab]

Thank you for the link. When you have an angiogram your consultant would be best placed to advise if there are actually blockages severe enough to require a stent. I am not sure if the patients in the trial had had angiograms?

My experience was in line with that given above.

My consultant was very good at explaining the angiogram as he went, and calmly asking if I wanted to proceed immediately with a stent. Although my symptoms were much milder than yours and I was running hard twice a week I had a 90% blockage of the main LAD artery which came as a surprise.

The procedure was simple and comfortable. As there was no damage to the heart I started cardiac rehab a few weeks later, and within 12 weeks was back to parkruns and am beating my times from 10 years ago. It is probably not just quality of life though.

My grandfather died of a cardiac event at my age 63, my mother had sever heart damage from a heart attack at a similar age and from my angiogram the cardiologist thought it was more likely than not I would have had a fatal heart attack too within the next 12 months.

Good luck!

[Henry20]

I had 2 stents in two procedures. Without them, I'd probably have had a heart attack. Meds alone wouldn't have cleared the blockages; 98% at one point. But it has to be your choice considering all you are told after the angio. It took several months to feel the real benefit, in my case.

Good luck, I'm sure you will make a decision you are comfortable with.

Henry

[Papou1]

Hello Bizzy, during October 2020 I was getting tightness in throat and chest. Went to see GP who sent me for an angiogram. The procedure was not uncomfortable ( 70% blockage of both LAD vessels at the split of the main arterý) also à partial blockage of the circumflex artery which was not in the correct place) l received a stent in each of the LAD offshoots. They would not touch the circumflex artery as they said that they would need to open up my chest but that things are good for now . Now on medication which seen to be working well. No pain or discomfort as Iong as I abide by the rules.

[tonysmithpi]

If its offered then take it. I struggled for 18 months suffering chest pain that went after rest. One day it didnt and a triple bypass followed. Maybe if I'd had a stent months earlier.........

[Qualipop]

I wouldn't be here after my heart attack when I had two stents to open up the blockage. I just wish they'd also done the two other blockages they found which, at 63% weren't quite bad enough to fit their criteria. I'm left wondering whether they've become worse

[EndyII]

Hello Bizzy,

Wanted to provide my experience, since I went through this and I ended up being a borderline case. Many of the examples are clear cut get a stent decisions. I had a number of tests that were not conclusive for ischemia. After a few visits to the AE, I ended up getting an angiogram. It was diagnosed with a 70% blockage in my distal LAD at the last branch point, along with a 50% and 30-40% blockages in some other arteries. My 70% blockage was a branch point, the stent was more difficult and could push part of the blockage into secondary healthy artery. Because of this, along with the fact it was in the distal portion of the lad (less heart muscle that could be impacted), and my blood flow was borderline, the cardiologist decided aggressive medication was the best course. If that did not work, we would revisit the stent. I am on high level of statins, asprin, etc. to stabilize the existing plaque, and to hopefully push off the need for a stent (for quality of life) till later. Post op, we discussed and he rationalized the use of meds over a stent, along with risks of stent and it made sense. Also, If if the blockage was higher in the LAD, or lower flow/high blockage etc. no question a stent would have been put in.

How the angiogram went. My cardiologist said that we would discuss the need for stent or not if it came up during the angiogram, you will be awake. Unless it was no-question a stent was needed, we would discuss it before it was done; and push it off if I was not comfortable. During the procedure, he mentioned there was some blockages but we would discuss after the procedure.

[JennyRx]

I had 100% RCA blocked but was only stented to reduce my breathlessness. They said that it wouldn’t reduce my risk, only improve my quality of life as there were tiny vessels that had already bypassed the blockage. So it couldn’t block any further. But I might get a blockage elsewhere as I have highly elevated lipoprotein (a) as the stents only cleared the one blockage. So the stents wouldn’t reduce my risk. They were clear about that it’s everything else that reduces my risk - lifestyle and meds not the stents.

[Knit4fun]

I didn’t even consider refusing a stent. I had a 90% blockage which was discovered during the angiogram and the stent was fitted there and then.

[Kelling]

What a statement to begin a post! A specialist does not offer a stent because he has some spare time or the stores ordered too many stents. You should be grateful to have been offered offered such a life saving procedure. Snap the chance up and move on to the rest of your life.

[Jetcat]

hi bizzy, it’s up to you at end of the day but there’s obviously a partial blockage if you’re getting offered the chance of the stent.?? I’d go for it if it was me in your position. I wish you all the best in whatever you decide to do mate. Best wishes. Ron.👍

[Mlinde]

Hmmm... Well, I've got a bunch of stents from 3 procedures over the past 10-11 years (2 heart attacks) and I suppose you can think of stents as a 'quick fix' but they don't actually address the issue of why arteries get blocked in the first place. The most common answer is cholesterol which I personally don't buy, cholesterol is one of the body's repair molecules and is actually essential for the body's health. It's actually produced in the skin as the result of exposure to sunlight and can be found in virtually every cell in the body. I think it's an extremely complex problem but essentially, the 'cause' of the blockage is inflammation of the artery walls and cholesterol, along with other chemicals are a response to the inflammation and they appear to form a 'scab' over the inflammation which in turn can block the artery. But we do know that inflammation can have multiple causes including smoking, stress and pollution. Dr Malcolm Kendrick has written some excellent books on the subject.

drmalcolmkendrick.org/

[Ruby300]

Hi, I had my HA March 2021 I was told I had a massive HA l had one stent the consultant told me we nearly lost you I am so grateful I am alive and well. It is up to you what you do but you have nothing to worry about. In fact all my family say I look better now then I did before 😊 so think about it it will change you life. Best wishes to you.

[wischo]

I too had mild symptoms bacically just feeling tired after a few mile walk and sitting down with no angina. I had a stress test which showed ST depression, had my angiogram during which my cardiologist told me I had a significant blockage at the top of the left coronary artery and asked me what I wanted to do. I asked his advice and his reply was that as its the main coronary artery supplying the heart he would advise stenting the blockage as the rest of my arteries showed very small amounts of plaque with a blockage rate of 15 to 25% elsewhere. I am not sure whether medication would have been appropriate or not but that was 4 years ago this month and no other problems have arisen. I too seen lots of similar articles like your post and I believe what they say is common sense, as a stent will only protect that small portion of the artery it is in and of course it does not guarantee any other heart problems will arise. You should be able to decide whats best for you during the angiogram and I hope you need little or no intervention as they will not put in stents unless they really deem them necessary.

[bizzy55 in reply to wischo]

Thanks. Did the stent improve your health or fitness?

[wischo]

Well the only symptoms I had were those episodes of having to sit down after a few miles and they have gone since, but I was also put on Ramipril, 1.25mg Bisoprolol and aspirin so it could be those. I try not to overthink these things and still walk 4 to 5 miles daily and a few upper body weights. Bearing in mind I am now 72 I do consider myself to be at least above average for my age group😉 but thats just me. Good luck on your angiogram.

[snowyy73]

Hi i had a mild attack at least i thought so i had the angiogram and they put a stent in there and then. I look back at it all and i think i have had a free service and MOT 😀 there's loads of people like me out there not knowing what there heart is like...not enjoying the Meds though!

[Karlyo]

my personal experience of stents (I have 2) is that they have transformed my life, from suffering angina regularly and one heart attack, to no symptoms at all for quite a few years now. When I was first offered an angio I refused as the risks scared me, and then a few months later I had the heart attack, which I was told I would have almost certainly avoided if I had agreed to the angio (when my stents would have been fitted in all probability), so my personal experience is that nowadays I pretty much always do what my cardiologist suggests! But of course, as has been said by others, we are all different and you should do what you feel happiest doing.

[Puffin1963]

...I'm not sure you have much choice if that's what they say you need - I certainly wouldn't refuse it