Bosiers et al on the use of DES for bilateral renal stenting, Granillo and colleagues (2005) described a single case receiving a paclitaxel-eluting stent in both renal arteries. In another case report, Kakkar and colleagues (2006) reported on the implantation of a paclitaxel-eluting stent (Scimed®, Boston Scientiﬁc, Maple Grove, MN, USA) in a patient with recur- rent renal artery in-stent restenosis. Angiographic control 6 months after index intervention showed continued wide patency of the treated vessel (Kakkar et al 2006). In an editorial comment, Zeller and colleagues (2006) described the potential role of DES in the treatment of renal artery stenosis. They made reference to the GREAT trial (Palmaz Genesis peripheral stainless steel balloon expand- able stent: comparing a sirolimus-coated vs.a bare stent in REnal Artery Treatment), the only trial which evaluates the efﬁcacy of DES in renal artery disease. In this nonrandom- ized, nonblinded, prospective, multicenter observational study, the sirolimus-eluting Palmaz Genesis™ Peripheral Stent (Cordis, Miami, FL) is compared with its bare metal counterpart in 105 consecutive, patients with symptomatic renal artery disease. Sapoval and colleagues (2005) published beneﬁcial results for the BMS arm of the study. Zähringer and colleagues (2007) published results from both arms of the study after 2 years of clinical follow-up. They reported that implantation of the sirolimus-eluting version led to an absolute reduction in the 6-month angiographic binary restenosis rate of 50% (BMS = 14.3%, DES = 6.7%; p = 0.30) After 1 year, the target lesion revascularization rate was 11.5% in the BMS group compared with 1.9% in the drug-eluting group (p = 0.21). Implantation of both BMS and DES led to signiﬁcant improvements in blood pressure, but 4%–7% patients had deterioration in renal function as measured by changes in serum creatinine. Despite, a trend toward improved outcome with DES in renal vasculature, the authors stated that the small sample size (n = 53) did not allow for detection of statistical signiﬁcance between groups. Zeller and colleagues (2006) conclude that DES might be beneﬁcial for patients with small renal arteries and impaired renal function. They believe that conventional BMS stent technology may lead to further deterioration in renal function because the need for reintervention exposes patients to recurrent administration of contrast and potential risk of renal embolism. According to their commentary, DES do not need to be used in patients with renal artery diameters greater or equal to 6 mm because results of exist- ing endovascular interventions are already associated with a low restenosis rate in renal vasculature of this size. They state that use of DES may be preferable in patients with 556 small diameter renal vessels ( 5 mm), a single, functional kidney or bilateral renal artery stenosis with small vessels, where the tendency toward inferior outcomes may justify the added expense and the risk of intensiﬁed, prolonged antiplatelet therapy with acetylsalicylic acid and clopidogrel (Zeller et al 2006). Supra-aortic arteries Extracranial vasculature Gupta and colleagues (2006) reported outcomes of DES in the extracranial circulation. They retrospectively reviewed data from 59 patients with either extra- (n = 36) or intracra- nial stenoses (n = 29) treated with Cypher® or Taxus® stents. The majority of the extracranial stents were implanted in the vertebral artery (n = 31) or the internal carotid artery (ICA) (n = 5). Most (95%) procedures were technically success- ful and the peri-procedural complication rate was 3% (one nonﬂow limiting dissection and one stroke). Follow-up angiography (n = 41) or computed tomography (n = 7) per- formed at a median of 4 months post implantation revealed a restenosis rate of 6% (Gupta et al 2006). Although these results are early and retrospective, they provide hope for patients with cerebrovascular atherosclerosis who have a 19% risk of ipsilateral stroke when medically treated (Kasner et al 2006). Two other authors have published case reports describing their experience with DES implanted for single extracranial lesions. Ko and colleagues (2004) mention in their report of 25 extracranial vertebral artery stenosis treated with balloon- expandable stents, the placement of one DES. At 1-month post-implantation, no adverse neurological events were observed (Ko et al 2004). In another case report Nussbaumer- Ochsner and colleagues (2006) present a patient with pre- procedural complaints of impaired left ocular perfusion and amaurosis fugax. The patient had occlusion at the origin of bilateral ICAs, stenoses of bilateral ECAs, and restenosis of the distal left CCA following prior endarterectomy. A Cypher® DES was implanted in the left ECA followed by placement of a non-drug-eluting self-expanding nitinol stent (Precise, Cordis. Miami, FL, USA) in the left CCA. The pro- cedure was uneventful, and the ocular symptoms resolved. At 6 months, the patient remained asymptomatic, with both stents being angiographically patent (Nussbaumer-Oschner et al 2006). Intracranial vasculature Abou-Chebl and colleagues (2005) collected data from 8 patients receiving a DES, 4 Cypher® and 4 Taxus® (Boston Vascular Health and Risk Management 2008:4(3)