As per the news reports, recently four patients died after botched emergency coronary angioplasty (one which they did not even need), which has raised questions on whether some doctors are advising unnecessary stents for patients whose heart conditions can be managed with therapy. Typically, angioplasty and stents are for patients with more than 80% blockage in arteries supplying blood to the heart. A coronary angioplasty is an invasive procedure to open clogged arteries to open clogged arteries. It is often followed by the placement of a small wire mesh tube called a stent, which is coated with medicine and helps keep the artery open.
Do medical malpractice/negligence occur while placing stent in a patient’s heart?
Yes they do occur. Here are the types:
Unnecessary procedure– A doctor may perform a stent procedure when other treatments would be better.
Improper hygiene– A doctor may cause an infection through poor hygein practices.
Procedural mistakes– A doctor may accidentally puncture an artery or vein during the procedure.
Failure to follow up– A doctor may fail to follow up with a patient after the procedure if their condition worsens.
Commission system– A doctor or hospital may take money at the patients expense through a commission system for stents.
Some other risks of having stent placed in an artery include:
- Allergic reactions to the contrast dye used during this procedure.
- Irregular hear beat.
- Bleeding or discomfort at the catheter insertion site.
- Damage to blood vessels from catheter.
What is stent policy in India
In February 2017, after studying the prevailing supply chain system, the government capped the prices of Rs 7260 for BMS type stents and Rs 29,600 for DES type stent. A bare-metal stent (BMS) is a type of stent made from steel, cobalt chromium, or platinum chromium that provides permanent support to an artery wall. BMSs were the first device used for coronary stenting and were a major improvement over balloon angioplasty. However, they have been largely replaced by drug eluting stents (DESs) in clinical practice.
Here are some differences between BMSs and DESs:
Efficacy– DESs have shown to be more effective than BMSs in reducing the risk of myocardial infraction (MI),mortality, and other adverse cardiac events.
Complications– DESs have fewer long-term complications than BMSs.
Drug Coating– DESs are coated with drugs that help prevent scar tissue formation and future blockages.
Use– DESs are recommended for more complex cases or patients who have had previous stent placement.
Clinical use- BMSs are still used in 20-3% of procedure.
At what point do you need a stent in your heart?
Generally people are told to go in for stenting if blockage is above 75% in the coronary artery, ultimately, it depends on the individual, current health status, and likelihood that the stent will improve the overall quality of life.
How much blockage is normal?
A moderate amount of heart blockage is typically that in 40-70% range. Usually heart blockage in the moderate range does not cause significant limitation to blood flow and so does not cause symptoms.
Things to do before going for angioplasty (stent placement)
- You must have complete information about the type and location of the blockage, and number of arteries involved. If blockage is partial and large arteries are not affected medication can be considered.
- If you are not satisfied with doctor’s suggestion, you should get second opinion. For second opinion, please carry the angiography film because mere report will not give clear picture.
- Take time to think and then decide. Anybody who can walk 500m to 1km distance without chest pain can wait.
- You are your family member before going in for procedure must ask the doctor or hospital to give full details of stent-company name, manufacturing date, code and size-used, and this should be mentioned on discharge summary. This will prevent cheaper stent being used at inflated cost.
In reality the doctors never give you much time to decide, as after the angiography when blockages are detected. They will say it will be easier to put the stent now as the catheter is already in the place and if we do not place the stent now, then patient will have to go in for the procedure once again for putting the catheter for stent placement.
About four years back, when I had a cardiac problem and doctor advised to go in for angiography, I had clearly told the doctor whatever be the blockages you will not perform the procedure of placing stent (angioplasty) as I might go in for second opinion or alternate treatment. But the doctor told my family members that if blockages are more, stent will have to be placed (for the reasons mentioned in the earlier paragraph). I was fortunate enough that my blockages in to arteries were below 60%, presently I am on medications.
In the end friends, if you or your family member had to go for angiography for detecting the blockages, please bear in mind all the things described in this blog, because many times doctors work on fear psychosis, to make money. I remember when in 1999 I had cardiac problem, my doctor told me that I recommend you for angiography my cut will be so much and for angioplasty so much. In India, this problem persist in all hospitals in the big cities.
Waiting for your feedback on this blog.
Anil Malik
Mumbai, India
27th November 2024