When it comes to cardiovascular medicine, few tools have transformed the field as dramatically as the coronary stent. For decades, these small mesh tubes have restored blood flow to blocked arteries, saving lives and preventing catastrophic heart events. Yet, while stents are invaluable in emergency settings, Dr. Andrew Rudin, a respected cardiologist known for his nuanced, patient-first approach, encourages both patients and physicians to ask a critical question before proceeding: Is this stent really necessary?
In Dr. Rudin’s view, the decision to place a stent should never be automatic. Instead, it should be made with thoughtful consideration, a review of the latest evidence, and an honest conversation between doctor and patient. His guiding philosophy is simple yet powerful: “Think before you stent.”
The Role of Stents in Cardiology
To understand Dr. Rudin’s perspective, it’s essential to first grasp what stents are and how they work. Stents are tiny, scaffold-like tubes inserted into arteries during a procedure known as percutaneous coronary intervention (PCI). They are most often used to treat coronary artery disease (CAD), a condition where arteries become narrowed due to the buildup of plaque, limiting blood flow to the heart.
In acute situations, such as a heart attack (myocardial infarction), placing a stent quickly can open a blocked artery and save heart muscle—sometimes even a patient’s life. In these emergency cases, there is universal agreement among cardiologists: a stent is absolutely the right call.
But what about patients who aren’t in immediate danger—those with stable angina or non-urgent blockages discovered during routine testing? This is where Dr. Rudin urges greater caution.
Stents Are Powerful—But Not Always Necessary
According to Dr. Rudin, the rise of interventional cardiology over the past two decades has led to a tendency to overuse stents in stable patients. “We now know from multiple high-quality studies that in many cases, medical therapy can be just as effective as stenting for reducing symptoms and preventing future cardiac events,” he explains.
One landmark study, the COURAGE trial, found that in patients with stable CAD, adding a stent to optimal medical therapy (including medications like beta blockers, statins, and aspirin) did not reduce the risk of heart attack or death more than medication alone. The more recent ISCHEMIA trial reinforced these findings, concluding that invasive procedures did not improve survival rates or reduce heart attacks compared to conservative management in patients with moderate-to-severe ischemia who were not experiencing unstable symptoms.
Despite this, many patients still undergo elective stenting out of fear or misunderstanding. “There’s this idea that if you find a blockage, you fix it immediately,” says Dr. Rudin. “But not every blockage is a ticking time bomb. Some can be safely managed with lifestyle changes and the right medications.”
Beyond the Arteries: Treating the Whole Patient
Dr. Andrew Rudin emphasizes that cardiovascular disease is a systemic condition, not just a series of individual blockages to fix. A stent might open one artery, but it doesn’t reverse the underlying process of atherosclerosis. That’s why, in his practice, he focuses not only on intervention but on prevention, education, and long-term care.
“Placing a stent can be the start of a new chapter—not the end of the story,” Dr. Rudin says. “We still need to manage cholesterol, blood pressure, blood sugar, diet, and exercise. Those are the things that really extend life.”
Patients who receive stents often require dual antiplatelet therapy (DAPT)—a combination of aspirin and another blood-thinning medication—for months or even years. This increases the risk of bleeding and affects decisions around surgery and other care. These risks must be considered, especially when the clinical benefit of stenting is marginal.
The Importance of Shared Decision-Making
In Dr. Rudin’s view, the decision to place a stent should be the result of shared decision-making—a collaborative process in which patients are presented with all available options, their pros and cons, and the evidence behind each approach.
“I’ve had patients come to me after seeing other doctors, already convinced they need a stent because they were told they have a 70% blockage,” he says. “But when we sit down and review their symptoms, their test results, and their risk profile, we often find that medication and lifestyle adjustments may be safer and equally effective.”
That doesn’t mean stents are never the right answer. “There are definitely times when stenting improves a patient’s quality of life—especially if they have frequent angina despite optimal medical therapy,” Dr. Rudin notes. “But it should never be a knee-jerk reaction. It should be an informed, deliberate decision.”
When to Think Twice About Stents
Dr. Rudin identifies several scenarios in which it’s especially important to pause and consider alternatives before stenting:
- Stable patients without symptoms who had a blockage discovered incidentally.
- Patients with multiple medical conditions that increase the risk of complications from stenting or antiplatelet therapy.
- Individuals with mild symptoms that can be managed with medication and lifestyle changes.
- Older adults or those with limited life expectancy where the long-term benefit is unclear.
“In these cases, rushing into an intervention may do more harm than good,” he explains. “It’s not about withholding care—it’s about offering the right care.”
Cardiac Care That Looks Ahead
As a seasoned clinician and a teacher to younger physicians, Dr. Rudin hopes the future of cardiology continues to balance innovation with critical thinking and empathy. He supports advancements like bioresorbable stents and improved imaging technologies, but he is cautious about the over-commercialization of procedures that are not always necessary.
“We have to remember that just because we can do something, doesn’t mean we always should,” he says. “The best cardiology isn’t about doing the most procedures—it’s about doing what’s best for each patient.”
He advocates for greater investment in preventive cardiology, lifestyle medicine, and public education—areas that often receive less attention than procedural interventions but have profound, long-lasting impacts on heart health.
Final Thoughts: Thoughtful Care, Better Outcomes
“Think before you stent” is more than a catchphrase. For Dr. Andrew Rudin, it’s a philosophy grounded in evidence, patient advocacy, and ethical medicine. It reflects a belief that the best healthcare decisions are those made slowly, with honesty, context, and collaboration.
While stents remain essential tools in saving lives, they are not cures in themselves. The heart is more than arteries—it is a reflection of lifestyle, stress, genetics, and long-term habits. And addressing those root causes is where true healing begins.
As cardiology continues to evolve, physicians like Dr. Rudin are leading the way with a mindset that puts patients first, respects the science, and never loses sight of the human side of medicine.