MASSDEVICE ON CALL — Noted physicians, from Dr. Oz to published cardiovascular experts, have warned of the dangers of over-using cardiac stents in patients who may not derive a survival benefit from the devices, but a fresh look suggests that the implants may be "necessary" after all, improving patients’ quality of life.

Headlines have targeted over-stenting and courts have condemned doctors whose methods were deemed inappropriate according to accepted guidelines, citing respected studies that suggest drug therapy is just as good as stenting, wrote Philadelphia V.A. Medical Center cardiologist Lisa Rosenbaum.

But the real-world picture is complicated by lower patient adherence to medication regimens and cases that don’t fit the clinical trial scenarios. New studies further suggest that the extra stents may have a survival benefit after all, not to mention renewed attention to findings that the stents may improve patients’ general well-being.

Over-stenting has landed a handful of doctors in hot water in a very public way. Maryland cardiologist Dr. Mark Midei and his former employer Catholic Health Initiatives were sued by more than 200 patients who claimed they’ve been implanted with unnecessary stents. Maryland stripped Midei’s medical license in May 2012 after the state’s medical board decided that the doctor committed "repeated and serious" violations.

That lawsuit was settled on the eve of Midei’s testimony, reportedly without his agreement.

"I continue to maintain that the patients received necessary and appropriate care," Midei told reporters at the time.

He’s not the only cardiologist accused of over-stenting. Similar accusations were leveled against another Maryland physician, Dr. John Wang, in December 2011. In November of that year, Dr. John McLean, who also practiced in the Old Line State, received an 8-year prison sentence for Medicare fraud related to over-stenting. And last December, an interventional cardiologist in Louisiana began his 10-year sentence after losing an appeal.

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