Living the dream of no restenosis.

“If I am in a dream, please don’t wake me” are the now-fabled words spoken by Patrick Serruys while viewing follow-up intravascular ultrasound images of sirolimus-eluting stents. The dream of an effective treatment for restenosis has eluded decades of effort by an army of investigators. Scores of devices, hundreds of drugs, and innumerable revascularization “strategies” have failed to eliminate the 10% to 50% risk of recurrence after angioplasty. The wasteland of failed anti-restenosis trials was expanded this summer by the 11 500-patient, hundred million dollar, mega-trial Prevention of REstenosis with Tranilast and its Outcomes (PRESTO), which demonstrated that tranilast (a cytokine inhibitor showing superb results in smaller pilot studies) was no better than placebo. When you take out a gallbladder, it doesn’t grow back. Yet, no matter how much skill, experience, time, and effort the interventionist brings to the table, restenosis can entirely reverse a perfect procedural result within months. Until now, only the efficacy provided by vascular brachytherapy has offered hope to patients with in-stent restenosis.