Doctor and patient discussing heart stent options.

Stent Choice: Are Your Preferences Heard?

Avery Sinclair in Health & Wellness December 2025 • 3 min read.

"Unveiling the disconnect between patient values and medical decisions in coronary stenting."

Choosing the right coronary stent—a tiny mesh tube that props open clogged arteries—is a critical decision for individuals with heart disease. While doctors weigh factors like the severity of the blockage and the patient's overall health, a recent study highlights a concerning disconnect: are patient preferences truly being considered?

Published in Catheterization and Cardiovascular Interventions, the study by Quintar et al. investigated how patients prioritize various outcomes associated with different types of stents—drug-eluting stents (DES) and bare-metal stents (BMS). DES reduce the risk of artery re-narrowing but require longer-term use of anti-clotting medications. BMS, on the other hand, carry a higher risk of re-narrowing but require less medication.

The study revealed that while patients have distinct concerns—such as avoiding repeat procedures, minimizing medication costs, and reducing the risk of bleeding—these preferences often don't align with the type of stent they ultimately receive. This raises questions about the extent to which shared decision-making is truly happening in cardiology.

Preference vs. Practice: The Stent Selection Gap

Doctor and patient discussing heart stent options.

In the Quintar et al. study, researchers surveyed 317 patients prior to diagnostic angiography, asking them to rate the importance of various potential consequences of stent choice. These included the need for repeat procedures, the number of daily medications, medication costs, risk of bleeding, and the need to delay future surgeries or dental work.

The results indicated that:

14.4% of patients ranked avoiding repeat procedures as their top priority.
20.6% prioritized other factors, such as medication burden or bleeding risk.
A significant 65% considered avoiding repeat procedures as equally important to other concerns.

Despite these varying preferences, a striking 85% of patients who underwent stenting received DES. Furthermore, there was no correlation between patients' stated concerns and the type of stent they received, suggesting a lack of individualized decision-making.

Empowering Patients: A Call for Shared Decision-Making

The study underscores the importance of actively involving patients in the stent selection process. As Dr. Blankenship points out, simply asking patients to rate the importance of general consequences isn't enough. Patients need clear, personalized information about the marginal risks and benefits of each stent type in their specific situation.

For instance, understanding the actual cost difference between DES (including the cost of longer-term anti-clotting medication) and BMS, or the precise increase in restenosis risk with BMS, is crucial for informed decision-making. Tools like PREDICT can help facilitate these conversations.

Ultimately, the goal is to move beyond a one-size-fits-all approach and ensure that stent choices reflect individual patient values and priorities. This requires open communication, a willingness to explore patient concerns, and a commitment to shared decision-making in interventional cardiology.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1002/ccd.27304, Alternate LINK

Title: Patient Preferences Prompt A Peek At Priorities

Subject: Cardiology and Cardiovascular Medicine

Journal: Catheterization and Cardiovascular Interventions

Publisher: Wiley

Authors: James C. Blankenship

Published: 2017-09-01

Everything You Need To Know

What is a coronary stent, and what are the main types available?

A coronary stent is a small mesh tube used to keep clogged arteries open, improving blood flow to the heart. There are primarily two types: drug-eluting stents (DES) and bare-metal stents (BMS). DES are designed to reduce the risk of the artery re-narrowing after the procedure but require a longer course of anti-clotting medications. BMS, on the other hand, have a higher chance of re-narrowing but need less medication. The choice between DES and BMS depends on various factors, including the patient's overall health, the specific characteristics of the blockage, and, importantly, the patient's preferences regarding medication and potential risks.

According to the Quintar et al. study, what key disconnect was found regarding stent selection?

The Quintar et al. study revealed a significant disconnect between patient preferences and the type of stent they receive. While a portion of patients prioritize avoiding repeat procedures, others prioritize factors like minimizing medication burden or bleeding risk. However, the study found that a large majority of patients received drug-eluting stents (DES), regardless of their stated preferences. This highlights a potential gap in shared decision-making, where the stent choice may not fully align with what matters most to the individual patient.

What factors were the study participants asked to consider when choosing a stent, and why are these factors important?

The study participants were asked to rate the importance of various potential consequences of stent choice, including the need for repeat procedures, the number of daily medications, medication costs, risk of bleeding, and the need to delay future surgeries or dental work. These factors are critical because they directly impact a patient's quality of life and healthcare management. Understanding these priorities helps doctors tailor treatment plans that best fit each patient's unique circumstances and values. However, the study revealed that these patient-defined priorities often did not influence the final stent selection.

Why is shared decision-making so important when it comes to choosing between different types of stents?

Shared decision-making is crucial in coronary stenting because the choice between drug-eluting stents (DES) and bare-metal stents (BMS) involves trade-offs. DES reduce the risk of re-narrowing but require longer-term anti-clotting medications, while BMS carry a higher risk of re-narrowing but need less medication. By actively involving patients in the decision, doctors can ensure that the chosen stent aligns with the patient's values and preferences, leading to better outcomes and satisfaction. Dr. Blankenship emphasizes the need for clear, personalized information about the marginal risks and benefits of each stent type to facilitate informed decisions.

What are the potential implications if doctors don't adequately consider patient preferences when choosing a stent?

If patient preferences aren't adequately considered, there could be several implications. Patients may feel dissatisfied with their treatment, potentially leading to non-adherence to medication regimens or follow-up appointments. If a patient who highly values avoiding repeat procedures receives a bare-metal stent (BMS) and subsequently requires another intervention, they may experience unnecessary anxiety and frustration. Conversely, if a patient who is concerned about long-term medication receives a drug-eluting stent (DES), they may struggle with the required medication regimen, increasing their risk of side effects or complications. Ultimately, neglecting patient preferences can undermine the trust between patient and doctor and negatively impact the overall success of the treatment.