This report originally appeared in the April 2011 issue of DOTmed Business News

When Bill Clinton received two stents to treat a blocked coronary artery last year, the world took notice—not just due to his celebrity, but because stenting has become one of the most controversial procedures in the United States.

The issue has experienced renewed interest in recent months. In early March, two western Pennsylvania doctors voluntarily resigned after investigation into their practices involving the procedure. Drs. Ehab Morcos and George Bou Samra, cardiologists at Westmoreland Hospital in Greensburg, Penn., were found to have implanted stents—thin wire scaffolds that unclog and prop open blocked arteries—in 141 patients who may not have needed them.

Meanwhile, in Baltimore, courtroom drama is unfolding around Dr. Mark G. Midei, who is accused of falsifying hundreds of medical records at St. Joseph Medical Center and inserting stents into patients who did not need them. Midei gained notoriety when the Senate released a report in December 2010, detailing his relationship with Abbott Laboratories, a stent manufacturer.



The report contended that Midei may have implanted 585 medically unnecessary stents between 2007 and 2009. The estimated cost of the unnecessary procedures topped out at $6.6 million, with Medicare picking up $3.6 million of the tab. The report also found that Abbott Labs rewarded Midei with thousands of dollars in perks. In one of the more infamous instances, Midei was found to have implanted 30 stents in a single day. Two days later, Abbott Labs spent $2,159 to host a celebratory dinner at Midei’s house.

But the issue is not just limited to litigations. Dr. Gerry Gacioch, head of cardiology at Rochester General Hospital in Rochester, N.Y., says that details can often be lost in the drama of courtroom disputes. “The more the people understand the nuances, the better,” Gacioch says.

Placing a stent in a patient is a complicated process, according to Gacioch, one that requires balancing existing protocol with the individuality of each patient. A patient being considered for a stent is first assessed using either a stress test or a heart scan to determine if any heart muscle is being deprived of oxygen.

If the artery is blocked, a catheter tipped with a deflated balloon, surrounded by a stent in a compressed form, is threaded into the patient’s circulatory system. Once the stent is in place, a balloon is inflated to expand the stent and to push the plaque against the walls of the artery to clear the blockage.

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