International Circulation: So what options do we have in treating DES restenosis?
　　Dr. Waksman: Not many interestingly. The most practical way is to understand the mechanism because if this is a very focal restenosis and is not a stent fracture then sometimes a balloon alone would be sufficient and we don’t have to go to any major expense. The other common approach is to use another drug eluting stent. In this case you have two options: using the same type of DES or replacing it with another DES with a different class of medication perhaps. For example， if you had a TAXUS with paclitaxel， you would move to everolimus or Cypher， and vice versa. However， there is no data to support whether you should switch or use the same DES. The next option that is emerging now is the drug eluting balloon， but most of the data on the drug eluting balloon is focused on BMS restenosis not DES restenosis. In the CRT meeting just concluded， there was one presentation of a study called the Valentines Trial that did show that the drug eluting balloon is associated with a reduction in restenosis for DES but not so effective for restenosis with BMS. That study is the largest data set that we have and its numbers are limited to less than a hundred patients with 80% DES restenosis. It is really not a lot of data. I will say that in the United States， we are also using brachytherapy which is also helpful. But when you review all the options， it really doesn’t make much difference what you are doing because at the end of the day when you have restenosis of a DES， the likelihood that this will recur within a year and a half is almost 15% - no matter what you do.  After that it is probably less， but we do not follow-up that many patients for such a long period of time.