Satheesan calls out ‘unnecessary’ angioplasty: Who needs a stent, who doesn’t?

Kerala Chief Minister V D Satheesan has called for a campaign against what he sees as "unnecessary" angioplasty procedures, sparking debate among doctors. These procedures involve opening narrowed or blocked heart arteries with a small balloon, often followed by stent placement to keep the artery open. While angioplasty can be life-saving in certain situations, it may not always be necessary, according to doctors.

The Indian Medical Association (IMA) agrees that unnecessary procedures should be avoided but warns that broad statements could undermine patient trust and discourage those who genuinely need treatment from seeking it. Kerala ranks third in stent usage, after Maharashtra and Karnataka, according to data from the National Interventional Council.

Cardiologists stress that the decision to use angioplasty must be made on a case-by-case basis, considering the patient's clinical condition, test results, and risk factors. Dr Ambuj Roy, a professor of cardiology at AIIMS, says the procedure is particularly useful when performed promptly during a heart attack, but for stable coronary artery disease, its role is more limited.

Dr Rajeev Jayadevan, convenor of the IMA's research cell in Kerala, explains that stent placement is a complex decision tailored to each individual patient, guided by established guidelines, diagnostic findings, and specialized training. However, angiogram results alone may not always be enough to decide on angioplasty. Doctors consider factors such as narrowing severity, blood flow reduction, patient symptoms, blockage location and complexity, and overall clinical picture.

They may also require additional tests. Patient confusion often stems from information asymmetry, where patients heavily rely on their cardiologist's interpretation of an angiogram showing a certain blockage percentage. This overuse of stents, sometimes encouraged by insurance schemes, has led to some patients refusing treatment even during acute heart attacks, when timely angioplasty can save lives.

Dr Jayadevan emphasizes that the complex factors leading to a specialist's clinical decision are rarely known to an outside observer, and generalized public commentary should be avoided. Patients should seek clarification through appropriate medical bodies and clinical audit forums.