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Stents are used too often
  1. K K HAASE,
  1. University of Tuebingen,
  2. Medical Clinic III,
  3. Otfried Muellerstrasse 10,
  4. 72076 Tuebingen, Germany

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We can forgive a man for making a useful thing as long as he does not admire it. The only excuse for making a useless thing is that one admires it intensely. The Picture of Dorian Gray—Oscar Wilde

Although percutaneous treatment of focal coronary artery lesions by conventional balloon angioplasty has gained widespread acceptance, it remains limited by the persistence of two problems: abrupt vessel closure early after intervention and restenosis during follow up. Stenting has become an effective treatment for abrupt or threatened vessel closure during conventional angioplasty. Furthermore, prospective trials have demonstrated that its clinical efficacy is superior to that of conventional balloon angioplasty for primary restenosis prevention in focal lesions of native coronary arteries.1 ,2 Some cardiologists consider stents as a breakthrough technology in that they might not only reduce restenosis rates but also improve most angiographic results achieved by conventional balloon angioplasty. The policy to achieve an optimal or even super-optimal angiographic lumen by scaffolding the artery with mechanical implants has dramatically reduced the phenomena of early elastic recoil as it virtually abolished the elasticity of the stented vascular segment.

In most laboratories where interventional procedures are commonly performed, at least 40–50% of cases involve the permanent implantation of a stent. This veritable “see change” or “oculomotoric policy” is the most radical transformation in the field of interventional cardiology since its birth in 1977. Indeed, metal prosthetic implants in the coronary artery circulation have become an extraordinarily routine procedure. At least 350 000 patients worldwide had at least one coronary stent implanted in 1997.3

Historical aspects

The first results of the …

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