The Hindu Business Line : No heartache on `overuse' of stents, say doctors

A decision in the best interest of the patient can be taken if the cardio-surgeon and the cardiologist could take a joint decision on the procedure to be used.

Mumbai , Dec. 13

IT can be a harrowing experience when heart patients have to decide between going in for a bypass surgery or having a stent used to remove blood-vessel blockages in the heart.

But do patients need to worry about the "overuse" or abuse of angioplasty and stenting as well, with medical-device companies hard-selling stents to doctors in the country?

Allaying fears of "overuse", Dr Prafulla G. Kerkar says that stents are used after taking into consideration the patient's age, affordability, medical profile and co-morbid condition i.e. whether the patient has other health considerations such as a lung problem, etc which become critical when general anaesthesia is used.

"It is not as though stent companies are pushing their products through doctors," he says in defence of his tribe. Dr Kerkar heads the Cardiology Department at Mumbai's K.E.M Hospital and is also a consultant with the Asian Heart Institute.

Doctors take a decision based on a certain medical rationale. But the patient could be in a dilemma with the surgeon suggesting surgery and the cardiologist advising the use of a stent, for instance. A decision in the best interest of the patient can be taken if the cardio-surgeon and the cardiologist could take a joint decision on the procedure to be used, he observes.

Dr G.R. Kane, an interventional cardiologist with hospitals in Mumbai, including the Hinduja Hospital points out that doctors have guidelines to assess whether a particular heart condition needs a bypass surgery or a stent. A decision is taken depending on the medical features of each case, he says.

Stents are wire-like devices that are used to remove blockages in blood vessels and the process is gaining in popularity in the country given the convenience it offers. Unlike surgery, it does not involve "cutting-up the body", explains Dr Kane. A "puncture" is made in the body through which the stent is inserted.

Stents are priced between Rs 50,000 and Rs 1.20 lakh and international stent-makers such as Boston Scientific and Johnson and Johnson already have a presence in India. Some Indian companies are also present in this market.

There are conditions where surgery is more beneficial, for instance if a person's heart has 60 per cent pumping capacity, has multiple blockages and is diabetic. A stent may be beneficial where the person may have only a single block with no other complications, Dr Kane explains.

But the doctor is best placed to assess the medical features of each case before deciding how to follow-through, he states emphatically. Dr Kane had moderated a discussion on the use, overuse and abuse of angioplasty and stenting at the Asian Pacific Congress Of Cardiology and the Annual Conference Of Cardiology Society Of India that recently concluded in the city.