Can we afford to eliminate restenosis? Can we afford not to?

Over the past decade, coronary stenting has emerged as the dominant form of percutaneous coronary revascularization. However, bare metal stents remain limited by a high incidence of restenosis, leading to frequent repeat revascularization procedures and substantial economic burden. Antiproliferative drug-eluting stents (DES) have recently demonstrated dramatic reductions in rates of restenosis, compared with conventional stenting, but important concerns about their costs have been raised. In this article, we summarize current evidence on the economic impact of restenosis and explore the potential benefits and economic outcomes of DES. In addition to examining the long-term costs of this promising technology, we consider the potential cost-effectiveness of DES from a health care system perspective and the impact of specific patient, lesion, and provider characteristics on these parameters.     

The interventionalist's dilemma: innocent intimal hyperplasia or in-stent restenosis?

This editorial refers to "Alpha-adrenergic receptor blockadeand hyperaemic response in patients with intermediate coronarystenoses" by A. De Bruyne et al. on page 2034 and "Uutilityof the fractional flow reserve in the evaluation of angiographicallymoderate in-stent restenosis" by Lopez-Palop et al. on page2040. One of the remaining challenges in interventional cardiologyis in-stent restenosis. In-stent restenosis is difficult totreat, often recurs, and may require repeated interventionsincluding bypass surgery and is therefore often frustratingfor both the patient and the physician. If in-stent restenosis is severe and the relation with the patient'scomplaints or proven ischaemia is clear, there will be littlediscussion about the necessity to use the     

Can we use statins to prevent stroke in Fabry disease?

Summary  Fabry disease is a rare, X-linked lysosomal storage disease caused by an inborn deficiency of α-galactosidase A, which results in the progressive accumulation of globotriaosylceramide and other neutral glycolipids in a range of cells and tissues. In association with the renal and cardiac insufficiency, cerebrovascular complications can result in the death of the patients. Several mechanisms causing vascular damage that leads to the development of deep-white matter lesions have been described. Recent clinical trials strongly suggest that statins protect against stroke by neuroprotective properties or pleiotropic effects. Aim: To evaluate evidence and potential beneficial effects of statins in the vasculopathy of Fabry disease. Competing interests: None declared