Think Before You Stent: Dr. Andrew Rudin on the Art of Thoughtful Cardiac Care

In the era of advanced cardiovascular interventions, stents have become one of the most widely used tools in modern medicine. These tiny mesh tubes, used to prop open narrowed or blocked arteries, have saved countless lives—especially during acute heart attacks when restoring blood flow quickly is essential. But while stents are life-saving in emergencies, their use in stable patients requires deeper consideration.

Dr. Andrew Rudin, a leading voice in patient-centered cardiology, is a strong advocate for evidence-based medicine and individualized treatment plans. His message is clear: Think before you stent. Not every narrowed artery needs a stent, and not every patient benefits equally from one.

The Rise of Stents: A Success Story—With Caveats

There’s no denying the transformative power of stents. Since their widespread adoption in the 1990s, stents have dramatically improved outcomes for patients experiencing myocardial infarction (heart attack). The ability to mechanically open a blocked artery within minutes can mean the difference between life and death—or between a strong recovery and permanent heart damage.

However, as Dr. Rudin explains, the expansion of stent usage beyond emergency settings has outpaced the science in some cases. “We’ve gone from using stents as urgent rescue tools to treating stable patients with them—often without fully weighing the alternatives,” he says.

For patients with stable coronary artery disease—meaning their symptoms are manageable and their condition is not immediately life-threatening—clinical trials have shown that medical therapy alone (like statins, aspirin, and blood pressure control) can be just as effective in preventing heart attacks and improving long-term outcomes as stenting. In fact, large studies like the COURAGE trial and ISCHEMIA trial have reinforced this perspective.

Stents Relieve Symptoms—But May Not Prevent Heart Attacks

One of the most common misconceptions, according to Dr. Rudin, is that stents “fix” coronary artery disease or prevent future heart attacks in stable patients. “That’s simply not what the data shows,” he says. “In patients with stable angina, stents can relieve chest pain, yes—but they don’t reduce the risk of future cardiac events more than medication and lifestyle changes.”

This insight is critical. Patients who undergo elective stenting may believe their heart disease has been cured, when in fact the underlying condition—atherosclerosis—still requires long-term management. A stent treats a specific blockage; it doesn’t address the systemic disease process that led to it.

As a result, Dr. Rudin emphasizes comprehensive care: aggressive risk factor control, smoking cessation, physical activity, and a heart-healthy diet, regardless of whether a stent is placed.

Informed Decision-Making: Empowering the Patient

For Dr. Rudin, the mantra “think before you stent” isn’t a critique of the procedure itself—it’s a call for better shared decision-making between doctors and patients. Too often, patients undergo interventions without fully understanding the risks, benefits, or available alternatives.

“Before we bring someone into the cath lab, we need to talk to them—not just about anatomy, but about their lifestyle, their symptoms, their goals,” he says. “Do they understand the difference between symptom relief and survival benefit? Have we optimized their medical therapy first?”

In his own practice, Dr. Rudin frequently sees patients who were told they “needed a stent,” but weren’t given the full picture. Many are surprised to learn that, in stable conditions, a stent may not be necessary—and that there are often safer, less invasive options with comparable outcomes.

By slowing down the process and having these candid conversations, he helps patients make truly informed choices—not decisions made in fear or under pressure.

The Risks of Unnecessary Stenting

While stenting is generally safe, it is not without risks. Complications can include bleeding, allergic reactions to contrast dye, kidney injury, or, in rare cases, vessel damage or clot formation inside the stent (in-stent thrombosis). Patients must also take blood thinners for a significant period afterward to prevent clots, which increases the risk of bleeding complications.

In patients who don’t urgently need a stent, avoiding an unnecessary procedure can spare them these risks—and the costs that come with them.

Dr. Rudin also points out that each intervention changes the future landscape of cardiac care. “Once a stent is placed, it becomes part of your long-term management plan. It can affect what medications you need, your eligibility for future procedures, and how your heart is monitored.”

A Better Approach: Patient-Centered, Evidence-Guided Care

At the core of Dr. Rudin’s philosophy is a simple principle: treat the patient, not just the artery. That means looking beyond angiograms and test results and focusing on the whole person—their symptoms, lifestyle, values, and preferences.

When a patient presents with stable angina or evidence of coronary artery disease, Dr. Rudin begins with optimal medical therapy: cholesterol-lowering medications, blood pressure control, anti-anginal medications, and lifestyle coaching. He monitors closely and reassesses symptoms over time. If the patient’s condition doesn’t improve, or if they begin to show signs of more serious ischemia, then stenting may become the right choice.

By taking this stepwise approach, Dr. Rudin ensures that every stent placed is truly necessary, and that every patient feels confident in the care they receive.

Educating the Next Generation of Cardiologists

As a mentor and educator, Dr. Rudin is committed to instilling this thoughtful approach in young physicians. In an era of high-volume procedures and financial pressures, he encourages future cardiologists to stay grounded in ethics, evidence, and empathy.

“Don’t fall in love with the technology,” he tells trainees. “Fall in love with the process of helping people—not just with your hands, but with your head and heart.”

He teaches that the best cardiologists are not the ones who do the most procedures—but the ones who ask the right questions, respect the data, and build trust with their patients.

Conclusion: Think First, Then Act Wisely

The ability to place a stent is one of modern cardiology’s greatest achievements—but with great power comes great responsibility. Dr. Andrew Rudin’s message to patients and physicians alike is both timely and timeless: think before you stent.

Through careful evaluation, open dialogue, and evidence-based decision-making, he helps ensure that interventions are meaningful, necessary, and beneficial—not just for the artery, but for the person behind it.

In a healthcare system often driven by speed and volume, Dr. Rudin’s thoughtful, measured approach offers a model of integrity, compassion, and clinical wisdom. And for patients navigating the uncertain terrain of heart disease, that’s the kind of care that truly heals.