International Circulation:  What suggestions can you give about the use of drug eluting stents in small vessels and heavily calcified lesions?

David Holmes: I guess that is a very important one because those vessels， number one have increased rest enosis rates.  If you are looking to prevent re-stenosis we use drug-eluting stents all the time.  We use drug-eluting stents also in diabetic patients who， as a population， have more re-stenosis.  Having said that， that is a group of patients who already have a greater burden of atherosclerotic disease.  That group patients with a greater burden of atherosclerotic disease do benefit， whether it be from medical therapy or with better stent technology， from prolonged dual anti-platelet therapy.  We use drug-eluting stents in higher risk patient groups realizing that higher risk patient groups have more burden of atherosclerotic disease and dual anti-platelet therapy， for medical therapy， is improving these population outcomes.

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