Which stent should I have?

On the topic of coronary artery stenting for angina, patients are now given the choice of a number of forms of stent, or at least their cardiologist is. These include angioplasty without stent, angioplasty with a bare metal stent (as shown in the picture), drug eluting stents (where  a chemical is impregnated into the stent, and over the next 5 years is slowly released into the surrounding artery,) and more recently bioabsorbable stents (which are similar to the drug eluting stents, but the stent itself like resorbable absorbable stitches, dissolves, so that after a year or 2, is has vanished). These latter bioabsorbable stents are a great deal more expensive, and a recent study has shown that they in fact are less effective than the drug eluting stents. (click here for study)

So if your cardiologist suggest that you should have a stent, which one should you request?
Bare  mental stents are very good, but they do have a significant incidence of recurrence in the 1st couple of years.
Drug eluting stents these are undoubtedly the best and should be used whenever possible.
Bioabsorbable stents will almost certainly be taken off the market.

Do coronary artery stents work?

Stenting the coronary arteries for angina is one of the most commonly performed procedures performed today.
There is no debate that in patients with unstable angina (chest pain at rest or about to have a heart attack,) stenting is lifesaving. There is however some discussion on whether cardiologists are stenting more patients than they should. For example there is no evidence that it increases mortality or recurrent heart attacks, but until recently we have always believed that it reduced pain.

In the last few days a recent trial called OBITA has suggested that stenting for single coronary artery disease may be no better than a dummy procedure. In this study, 200 patients in the United Kingdom with only one narrowed coronary artery, were either stented, or had an angiogram but no stent, and then were followed up. At 6 weeks there was no difference in the patient's assessment of angina. (There was however improved exercise time, evidence of ischaemia (poor function) on stress echocardiogram, and the patients who had the dummy procedure were on more medications.

Nevertheless this has ruffled many feathers in the cardiac community.
While waiting for more evidence, what can we say?
1. Angioplasty and stenting is effective and lifesaving in patients with unstable angina.
2. The study was only for single coronary artery disease, and cannot be applied to patients requiring multiple stents.
3. It does mean that we shouldn't be so eager to step in and stent everything, if the patient is not getting a lot of angina (in the study this was the case), just because we show a narrowing in one coronary artery does not mean it should be stented.
4. Stenting is still the treatment of choice if the patient is getting a lot of angina, despite optimal medical treatment.

I believe this study simply confirms that we are stenting to many patients, but there is a real role for using this procedure as part of good cardiology management.