Stents: A Reflection

Dec. 12, 2006 — -- From time to time, every one of us gets a bee in our bonnet.

We have an idea that is so appealing, we can't let it go. It doesn't matter if others are less certain or even call the idea superstitious or unreasonable. But that belief feels so comfortable and so plausible that we defend it vigorously.

That sort of stubborn behavior is human nature. Physicians are human -- and, admittedly, stubborn.

Sometimes our beliefs turn out to be correct, to be prescient. Sometimes they don't.

Not long ago, tonsils were removed because they were swollen and uteruses because they were lumpy. Those surgeries turned out to be not so necessary and not so helpful. We got it wrong with stents, too. Let me tell you how.

Fifty years ago, heart attacks were a scourge. Everyone knew a working-age man who had dropped dead from one. Medicine seemed stymied. It was then that doctors learned what we all know now: The large arteries that feed the heart muscle, the coronary arteries, are clogged by a fatty buildup called atherosclerotic plaque in nearly every heart-attack patient.

Doctors thought cardiac surgery had made great strides in fixing leaky heart valves, so why not fix clogged arteries?

But removing the clog was too difficult, so pioneering surgeons developed ways to create blood vessels that actually went around -- or bypassed -- the obstructing plaques. Thus was born coronary-artery-bypass-graft surgery, or CABG. Experts firmly believed that if the blockage was bypassed, the patient was saved.