EDITORIAL Lost contact with vessel wall, signed contract with stent thrombosis?

This editorial refers to ‘Impact of incomplete stent appos-ition on long-term clinical outcome after drug-eluting stent implantation’†, by S. Cook et al., on page 1334 Drug-eluting stents (DES) represent the most successful approach in preventing restenosis after percutaneous coronary interventions (PCIs).1 Many believe, however, that reduction of neointima forma-tion is associated with a worrisome side effect, an increased risk of very late stent thrombosis, at least as observed with early DES technologies.2 An adverse vessel wall reaction to two DES components—drug and polymer—has been called into question.3–5 On balance, an increased risk for very late stent thrombosis seems to be the price to be paid for the dramatic reduction of restenosis with DES of earlier generations. A similar therapeutic imperfection related to PCI also exists for the adjunct antithrom-botic therapy: an increased risk of bleeding is the price still to b