Modern cardiology has made extraordinary strides in treating heart disease, with coronary stents playing a leading role in saving lives. These small, mesh tubes are often inserted into narrowed arteries to restore blood flow to the heart—a procedure that can be the difference between survival and catastrophe during a heart attack. But while stents are invaluable in emergencies, Dr. Andrew Rudin, a respected voice in cardiology, urges a more cautious approach when it comes to non-emergent cases. His message is simple: Think before you stent.
In recent years, the use of stents has expanded beyond emergency settings into more elective procedures for patients with stable coronary artery disease. These are individuals who may experience occasional chest discomfort or show signs of arterial narrowing during stress testing, but who are otherwise stable and not in immediate danger. In such situations, the instinct to “fix” the blockage with a stent can be compelling. But as Dr. Andrew Rudin emphasizes, instinct must be tempered by science—and by empathy.
He has spent decades in the field, witnessing the transformative power of stents when used appropriately. During acute myocardial infarctions, stenting restores circulation, reduces damage to the heart muscle, and saves lives. These cases are clear-cut and carry a well-established benefit. But in stable patients, the benefit is far less definitive. Multiple landmark studies, including the COURAGE and ISCHEMIA trials, have shown that in non-urgent cases, stenting does not reduce the risk of heart attack or death compared to optimized medical therapy. In other words, for many patients, pills and lifestyle changes work just as well—without the risks that come with an invasive procedure.
Despite this data, the rate of elective stenting remains high. For Dr. Andrew Rudin, this disconnect often stems from poor communication or a lack of comprehensive discussion between physician and patient. Too often, patients are presented with alarming terms like “blockage” or “narrowed artery” and feel that a stent is the only viable solution. In reality, a significant percentage of these blockages are stable plaques—unlikely to rupture—and pose no immediate threat. Stenting them may relieve symptoms, but it does not necessarily extend life or prevent future cardiac events.
That’s why Dr. Andrew Rudin takes the time to engage with each patient individually. He explains what their imaging shows, what their risk factors are, and how various treatment paths compare. He stresses that just because a narrowing appears on an angiogram does not mean it needs to be fixed with hardware. Sometimes, the better course is medical management: cholesterol-lowering medications, blood pressure control, daily aspirin, dietary changes, and exercise. These interventions not only stabilize disease but address the root causes behind it.
The choice to pursue a stent should never feel automatic. Every procedure carries some level of risk—no matter how common it has become. Potential complications from stenting include bleeding, allergic reactions to contrast dye, artery damage, and clot formation within the stent. These risks are relatively rare, but they are real, and for patients who might otherwise thrive on medication alone, they may not be worth taking. Dr. Andrew Rudin believes patients deserve a full picture, not just the promise of a quick fix.
His patient-centered approach is rooted in the idea that medicine works best when it’s collaborative. He doesn’t simply dictate treatment; he invites patients to participate in the process. What are their goals? What are their concerns? What is their tolerance for risk, and what is their quality of life like? These questions matter just as much as the test results. In fact, they often matter more.
For some patients, the best option may still be a stent—particularly if chest pain persists despite medication, or if quality of life is significantly impaired. In those instances, Dr. Andrew Rudin performs the procedure with precision and care, ensuring patients understand what the stent can do, and just as importantly, what it cannot. A stent can relieve discomfort, but it does not reverse heart disease. Only continued lifestyle management can do that.
That’s the part many patients miss, and Dr. Andrew Rudin is determined to change that. He believes strongly in prevention, rehabilitation, and education. He supports his patients long after the procedure is done—encouraging regular exercise, helping them quit smoking, and guiding them through diet changes. For him, the stent is just one step in a longer journey of healing.
In a healthcare environment where speed and volume often take precedence, his thoughtful, measured approach is increasingly rare—and increasingly needed. The pressure to “do something” can overshadow the wisdom of sometimes doing less, but doing it better. Dr. Rudin’s philosophy stands in quiet opposition to that trend. He brings the conversation back to the fundamentals: listen to the patient, study the evidence, weigh every choice carefully.
Ultimately, “Think Before You Stent” isn’t a rejection of stents—it’s a reminder that the best cardiac care is rooted not in routine but in reflection. Every patient is different. Every artery tells a story. And behind every scan is a person hoping for clarity, trust, and the best possible care.
Through his work, Dr. Andrew Rudin has become a model of what cardiology can be when it slows down enough to think, listen, and lead with wisdom. His legacy is not just in the lives he’s saved through intervention, but in the lives he’s improved by teaching that sometimes, the most powerful thing a doctor can do is wait, explain, and walk alongside the patient—one careful step at a time.