The stent has become part of the standard toolkit for the heart specialist. It's a crude, but effective, device for 'propping up' arteries that may collapse after angioplasty, or which may get blocked by a build-up of plaque in a process known as restenosis.
This micro-engineering has been actively used for the past 25 years - and it's only now just occurred to specialists that simple, and inexpensive, lifestyle changes work just as well.
A new trial, involving 2,297 heart patients with at least one blocked coronary artery, found that they fared just as well if they stopped smoking, exercised, and improved their diet.
They lived as long, if not longer, than the patients who were given a stent, but who otherwise carried on as before, and their quality of life was also far higher.
This is bad news for American heart specialists who routinely insert 1 million stents a year, funded by health insurance plans.
The new study, known as Courage (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation), may put an end to the "irrational exuberance that surrounds stenting", says Steven Nissen, immediate past president of the American College of Cardiology.
But don't bank on it. As another specialist said: "Once Courage was released, I asked myself how this would change my practice, and I realized it wouldn't."
Carry on stenting.
(Source: Journal of the American Medical Association, 2007; 297: 1967-8).
E-news broadcast 17 May 2007 No.360