Dr. Andrew Rudin, MD, on What Every Patient Should Know Before Getting a Coronary Stent

For many people, the idea of a “blocked artery” immediately triggers panic. And when a doctor says the word “stent,” the natural response is often relief: Good. Fix it. Now.

But not all blockages require a stent, and not all stents improve long-term outcomes. According to Dr. Andrew Rudin, MD, a nationally recognized cardiologist, one of the most important—and often overlooked—parts of cardiovascular care is patient understanding.

“Too many patients go into stenting procedures without knowing why,” Dr. Rudin explains. “They hear there’s a blockage and assume it must be fixed. But the reality is much more nuanced.”

This article offers a clear, evidence-based overview of what patients need to understand before receiving a coronary stent—and how to advocate for a conversation, not just a procedure.

What Is a Coronary Stent, Exactly?

A coronary stent is a small, expandable metal tube placed inside a coronary artery to restore blood flow that’s been reduced by plaque buildup. It’s delivered via catheter, usually inserted through the wrist or groin, and expanded with a balloon at the site of narrowing.

Stents are most effective when used during acute coronary syndromes—such as heart attacks—where they restore blood flow quickly and can be lifesaving.

However, for patients with stable coronary artery disease (CAD)—who have predictable or mild chest pain, or no symptoms at all—the benefits of stents are more limited.

The Key Question: Are You Stable or Unstable?

Before any stenting procedure, the most critical distinction is this:

Are your symptoms stable, or are you having a cardiac emergency?

If you’re experiencing:

• Chest pain at rest
• Shortness of breath not related to exertion
• A confirmed heart attack
• Unstable angina or ECG changes

…then a stent could save your life.

But if your symptoms:

• Occur only with heavy exertion
• Are controlled with medications
• Haven’t changed in weeks or months
• Appear during stress testing without acute distress

…then you are likely in the “stable” CAD category, where the benefits of stenting are less certain.

“This is where many patients get lost,” says Dr. Rudin. “They hear they have a blockage and assume it’s about to kill them. But the heart isn’t plumbing—it’s physiology. Blockage alone doesn’t always predict danger.”

What the Research Shows About Stable CAD

Multiple large-scale studies have examined whether stents improve outcomes in stable CAD. The results may surprise you.

🔹 The COURAGE Trial (2007)

Found that in stable patients, stenting did not reduce the risk of heart attacks or death compared to medications alone.

🔹 The ISCHEMIA Trial (2020)

Showed that even patients with moderate to severe ischemia did just as well with medical therapy as those who received stents—unless their symptoms were unmanageable.

🔹 The ORBITA Trial (2017)

In a unique study that used a placebo procedure, even symptom relief from stents was less dramatic than expected, suggesting a psychological component in some cases.

Questions Every Patient Should Ask

Before agreeing to a stent, Dr. Andrew Rudin, MD, encourages patients to ask their cardiologist a few essential questions:

• Is this an emergency?
• If not, there is time to explore all options.
• What are we trying to treat—symptoms or risk?

Stents help symptoms in some cases but don’t prevent future heart attacks in stable disease.

Have I tried medications first?

Optimal medical therapy should always be the first step unless symptoms are severe.

Is the blockage actually restricting blood flow?

Tests like fractional flow reserve (FFR) can help determine this.

What happens if I choose not to stent?

A good physician will respect your right to choose and explain the alternatives.

“Patients don’t need to be passive,” Dr. Rudin says. “They need to be partners. And that begins with asking smart, informed questions.”

Understanding Risk vs. Benefit

Every medical intervention carries risks. With stents, these can include:

• Bleeding or bruising at the catheter site
• Allergic reactions to contrast dye
• Stent thrombosis (rare, but serious)
• Need for lifelong medications (like antiplatelets)

When symptoms are severe, those risks are worth it. But in mild or asymptomatic patients, the risk-benefit ratio changes. That’s why Dr. Rudin—and many cardiologists—now emphasize a more thoughtful, individualized approach.

Empowerment Through Education

Too often, the cardiology encounter becomes rushed, technical, and one-sided. Patients may feel intimidated or pressured into procedures they don’t fully understand. But it doesn’t have to be this way.

Dr. Rudin is part of a growing movement within medicine to reclaim shared decision-making—an approach where clinicians and patients work together to evaluate all options.

“Our job isn’t just to treat the heart,” he says. “It’s to support the human being who lives with that heart every day.”

Final Thoughts: A Conversation Worth Having

The coronary stent is a powerful tool—but not every patient needs one. In cases of stable heart disease, medications, lifestyle changes, and close monitoring may offer the same benefits, without the risks or costs of intervention.

Dr. Andrew Rudin, MD encourages all patients to take an active role in their cardiovascular care. Ask questions. Understand the evidence. Know your options.

Because when it comes to your heart, the best decision is an informed one.