MB: Drug-eluting stents: costs versus clinical benefit. Circulation 2003; 107: 3008–3011

Since the advent of coronary angioplasty in 1977, theprocedure has changed from an uncommonly usedmethod of treating simple discrete lesions1 to one that challenges surgical revascularization.2 Step by step, major anatomic obstacles have fallen as this procedure has been applied to an expanding patient population. Technical breakthroughs including steerable and movable guide-wires, low-profile balloon shafts, atherectomy devices, and ultimately stent implantation have made percutaneous coronary intervention (PCI) more successful, safer, and more durable.3 Unfortunately, 2 major obstacles have limited PCI; these are chronic total occlusions and reste-nosis. The year 2002 will be remembered as the year in which one of these remaining obstacles fell. The recent publication of the RAVEL study4 (RAndomized study with the sirolimus-eluting VElocity balloon-expandable stent in the treatment of patients with de novo native coronar