[graeham]

Stents are an incredible piece of engineering, but probably are over-used (particularly in the USA). There are a few issues at play:

-Chest pain

-Artery narrowing

-Heart attack risk

They aren't the same, although there is correlation between each. The original idea behind stents was to stabilise vessels in the process of a heart attack. They are increasingly used in a preventative way - but the problem is there aren't very many or good tools to tell how at risk an individual is to a heart attack.

Another major problem (as the article mentions) is that stents improve the situation in one artery, but most patients that need a stent have atherosclerosis in multiple vessels. This likely explains why the chest pain remains.

[epmaybe]

I'm a little confused by this. Patients can get stents in multiple arteries during one cath lab session. Generally it's a diagnostic cath at first, finding all blockages, and deciding which vessels should be ballooned/stented. I've been in multiple procedures (shadowing, not performing) where they did 2+ vessels.

[graeham]

Agreed that multiple stents and multiple vessels can be stented in one cath session. My point was more that there isn't very strong evidence or criteria for what constitutes a vessel that should be stented versus which should not. Worse, plaques are dynamic – what looks benign today could rupture and cause a complete/near occlusion. Rupture and subsequent thrombosis is more dangerous than stenosis itself.