Stents have become a symbol of modern cardiology—a mechanical marvel that saves lives by opening clogged arteries and restoring blood flow. For many patients, the concept is simple: a blockage in the heart means a stent is necessary. But according to seasoned cardiologist Dr. Andrew Rudin, the reality is far more nuanced. The decision to place a stent should be guided by evidence, tailored to the patient, and made only after thoughtful dialogue. His advice is clear, and it comes from years of experience: think before you stent.
Dr. Rudin has performed and overseen countless interventions involving coronary stents. He acknowledges their value without hesitation, especially in emergency situations such as acute myocardial infarction. In these moments, every second counts, and restoring blood flow with a stent can be the difference between full recovery and permanent heart damage—or between life and death. In this setting, there is no debate: stents are life-saving. However, Dr. Rudin is equally vocal about a different, more subtle concern—the overuse of stents in patients who are stable, not in immediate danger, and often better served with medication, lifestyle changes, and ongoing monitoring.
In his view, the stent has, over time, become a default answer to a complex question. Part of the problem lies in the way cardiac imaging is interpreted and communicated. When a patient is told they have a 70% or 80% blockage, the instinct is to fix it mechanically. But not all blockages are created equal. Some are stable and unlikely to rupture, especially if the patient is not experiencing significant symptoms. Others may be in locations or at sizes that do not pose immediate risk. Dr. Rudin emphasizes that a blockage alone does not always justify intervention.
The science supports this cautious approach. Dr. Rudin points to major studies, including the COURAGE and ISCHEMIA trials, that showed no significant survival advantage or reduction in heart attacks when stents were used in stable patients compared to optimal medical therapy. In other words, for many people with manageable chest pain or limited symptoms, medications can be just as effective as stents—and often safer, cheaper, and less invasive.
Despite these findings, the practice of elective stenting remains common, partly due to habit and partly due to a lack of patient awareness. Dr. Rudin is passionate about correcting this. He believes that patients deserve full transparency and a clear understanding of their options. Too often, he says, people are told they “need a stent” without being offered the context they need to make an informed decision. For some, this creates unnecessary anxiety. For others, it leads to procedures that, while not harmful in themselves, do not improve outcomes and may expose them to avoidable risks.
Every procedure, no matter how routine, carries some degree of risk. With stents, there can be bleeding at the catheter site, allergic reactions to contrast dye, or rare but serious complications such as stent thrombosis. There is also the ongoing requirement for dual antiplatelet therapy—blood-thinning medications that can increase the risk of bleeding and complicate other medical treatments. Dr. Rudin does not present these risks to frighten his patients, but to inform them. His goal is not to steer people away from stents, but to help them understand when a stent is truly necessary and when other approaches may be more appropriate.
At the core of Dr. Rudin’s philosophy is shared decision-making. He does not see his role as simply diagnosing and prescribing. Instead, he views himself as a partner, helping patients navigate complex information and weigh the trade-offs of different treatment paths. He asks questions. What are the patient’s goals? How are their symptoms affecting their daily life? What other conditions are present that may influence outcomes? He listens carefully and explains clearly. By the end of the conversation, his patients don’t just understand their condition—they understand their choices.
For those who do not need a stent, Dr. Rudin emphasizes the importance of comprehensive medical therapy. This often includes cholesterol-lowering drugs like statins, blood pressure management, aspirin, and medications to reduce angina symptoms. Just as important are lifestyle changes—improved diet, increased physical activity, stress reduction, and smoking cessation. He acknowledges that this path requires more work and discipline than a 30-minute procedure, but the long-term benefits are profound. He has seen countless patients reduce their symptoms, improve their quality of life, and avoid future events without ever needing an intervention.
For patients who do need stents, whether due to symptom burden or high-risk anatomy, Dr. Rudin provides compassionate, meticulous care. His expertise in interventional cardiology ensures that these procedures are done with precision and follow-up care that prioritizes long-term success. But even in these cases, he frames the stent as one chapter in a broader story of heart health—not a cure, but a tool in a larger strategy to prevent disease progression.
He is also committed to educating the next generation of physicians. Through mentorship and medical education, he teaches young doctors not just the technical skills of stent placement, but the judgment and restraint required to know when it’s truly necessary. In an age where technology often races ahead of reflection, Dr. Rudin remains a voice of thoughtful balance.
His message resonates because it’s rooted in humility and clarity. He does not claim that stents are overused out of malice or incompetence. He understands the pressures of modern medicine—the desire to do something, to offer patients fast answers and immediate solutions. But he also knows that the best medicine is not always the most aggressive. Sometimes, the best thing a doctor can do is sit with a patient, review the data together, and decide not to intervene.
Dr. Rudin’s patients respect him for his honesty, his patience, and his integrity. They leave his office feeling informed, not rushed; respected, not lectured. In an industry where procedures often take precedence over conversations, he offers something increasingly rare: the gift of time, the strength of knowledge, and the wisdom to pause.
“Think Before You Stent” is more than a slogan. It is a philosophy of care rooted in responsibility, evidence, and empathy. Through his work, Dr. Andrew Rudin reminds us that the heart is not only a physical organ but a symbol of life’s complexity—and that treating it well means thinking carefully about every choice we make.