Think Before You Stent: Dr. Andrew Rudin’s Guide to Smarter Heart Care

It’s a scene that plays out in cardiology offices every day: a patient undergoes a stress test or coronary angiogram, a blockage is discovered, and the phrase “you need a stent” quickly follows. The patient, often anxious and unfamiliar with the nuances of cardiac care, agrees—believing the stent will prevent a heart attack or cure their disease. But according to Dr. Andrew Rudin, a respected and experienced cardiologist, the decision to place a stent is one that deserves more thought, conversation, and context.

“Stents are excellent tools in the right scenario,” says Dr. Rudin. “But like any tool, they must be used with care. We have to match the intervention to the patient, not just the image on the screen.”

Understanding What a Stent Does—and Doesn’t Do

A stent is a small, mesh-like tube inserted into an artery to keep it open after it has been widened with a balloon during a procedure called angioplasty. It’s a common treatment for coronary artery disease, especially in the context of acute coronary syndromes like heart attacks, where restoring blood flow quickly can mean the difference between life and death.

But what many patients don’t realize is that stents are not always necessary—and not always beneficial—outside of emergencies. “There’s a misconception that once a blockage is found, it must be fixed mechanically,” says Dr. Rudin. “But in patients with stable symptoms, the evidence tells a different story.”

The Evidence Behind Conservative Care

Two landmark studies have shaped modern thinking about stents in non-emergency settings: the COURAGE trial and the ISCHEMIA trial.

In the COURAGE trial, researchers followed patients with stable coronary artery disease and found that those treated with optimal medical therapy (such as statins, beta-blockers, lifestyle changes, and aspirin) did just as well in terms of heart attacks and survival as those who underwent stenting.

The ISCHEMIA trial, published more recently, echoed these findings—even in patients with moderate-to-severe ischemia (reduced blood flow to the heart). It concluded that invasive procedures like stenting did not reduce the risk of heart attack or death more than non-invasive treatment in patients who were stable.

“These are robust, well-conducted studies,” Dr. Rudin says. “And they’ve led many of us in the field to rethink when and why we reach for the stent.”

Why Some Patients Still Get Unnecessary Stents

Despite the research, thousands of patients undergo elective stenting every year—sometimes for the wrong reasons. Dr. Rudin believes this is often the result of poor communication and outdated assumptions.

“Patients often aren’t told the full range of options,” he explains. “They’re scared, they hear the word ‘blockage,’ and they assume something drastic needs to be done. But heart disease is complex. Not every blockage is dangerous.”

Indeed, many blockages are stable, meaning they’re not prone to rupture or cause sudden heart attacks. In those cases, a stent may relieve chest pain (angina), but won’t extend life or reduce the likelihood of future cardiac events compared to good medical therapy.

“That’s why we need to pause and talk,” says Dr. Rudin. “If we rush to intervene, we might expose patients to unnecessary risks without meaningful benefit.”

The Risks of Stenting

While stenting is generally safe, it is not risk-free. Complications can include:

• Bleeding or hematoma at the catheter insertion site

• Allergic reactions to contrast dye

• Damage to the artery

• Blood clots inside the stent (in-stent thrombosis)

• Need for long-term blood thinners, which can increase the risk of bleeding

“These are not minor concerns,” Dr. Rudin cautions. “We have to weigh them against the expected benefit—especially when we’re dealing with elective procedures.”

A Better Way: Patient-Centered Decision Making

Dr. Andrew Rudin’s approach to cardiology is rooted in collaboration. He believes that the best outcomes happen when patients are active participants in their care—not passive recipients of procedures.

In his practice, he begins by asking questions: How severe are the patient’s symptoms? How long have they been present? Have medications been optimized? What are the patient’s goals? What are their fears?

Only after exploring these questions does he discuss the role of procedures like stenting—and whether they are likely to offer relief or just give the illusion of action.

“I’ve seen patients who were told they ‘needed’ a stent, only to realize later that their symptoms weren’t cardiac at all,” he says. “That’s why we must treat the person, not just the artery.”

When Stents Are the Right Answer

None of this is to suggest that stents don’t have their place. In emergency settings, such as during an acute heart attack, stents are unequivocally lifesaving. They open blocked arteries fast, restore oxygen to heart muscle, and reduce the risk of permanent damage.

Stents may also be appropriate for patients with frequent, disabling angina that does not respond to medications. In these cases, the goal is quality of life, not necessarily survival.

“The key is knowing the difference,” Dr. Rudin says. “And making sure the patient knows it too.”

From Stents to Systems: Addressing the Bigger Picture

For Dr. Rudin, stent overuse is not just a clinical issue—it’s also a systemic one. In a healthcare environment that often rewards volume and speed, it’s easy for procedures to take precedence over counseling and prevention.

“We need more time for conversations,” he says. “Time to explain, to listen, to answer questions. That’s what builds trust—and better decisions.”

He advocates for stronger patient education, more comprehensive cardiac rehab programs, and greater emphasis on prevention through lifestyle change. After all, the best way to manage coronary artery disease isn’t to place more stents—it’s to prevent the disease from progressing in the first place.

Final Thoughts: It’s Not About Doing More—It’s About Doing What’s Right

“Think before you stent” is not a call to delay necessary care—it’s a reminder to proceed with wisdom, evidence, and empathy. It’s about recognizing that not every problem needs a procedure, and not every solution comes in a catheter lab.

In Dr. Andrew Rudin’s world, the best cardiology is about precision and partnership. It’s about choosing interventions carefully, respecting the data, and never losing sight of the human being behind the EKG.

“In the end,” he says, “our job is not just to fix hearts—it’s to care for people. And sometimes, the most powerful medicine is simply taking the time to think.” See more here.