BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7457.120 (Published 08 July 2004) Cite this as: BMJ 2004;329:120

Stents have come into routine use as part of coronary angioplasty so fast that little evaluation has been published. The latest innovation is the drug eluting stent, and a review from England (European Heart Journal 2004;25: 902-14) quotes a consensus panel in the United States as saying that “the rapid evolution of stent design, deployment approaches, and adjuvant therapy have led to changes in clinical practice that precede rigidly controlled supporting scientific data.” The National Institute for Clinical Excellence has recommended the use of drug eluting stents for patients with small vessels or long lesions but—says the journal—the policy is based on small numbers and short term follow up. Why the hurry?

Restenosis of a stent inserted during coronary angioplasty is thought to be less likely if the plasma concentration of homocysteine is low, and some research has suggested that this can be achieved by treatment with folic acid and vitamins B-6 and B-12. A randomised controlled trial (New England Journal of Medicine 2004;350: 2673-81) has now refuted that approach. Restenosis was more severe in the treated group, and cardiologists are warned that they should not give folate to patients who have had a stent inserted.

Another condition that has attracted the attention …

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