TOR of the cell cycle: Are there important implications for diabetics in the era of the drug-eluting stent?

The problem of restenosis in the diabetic population remains formidable even in the era of the drug-eluting stent. Experimental and clinical research is necessary to determine the optimal treatment for the prevention of restenosis in the diabetic patient. The data from the planned studies with the sirolimus-eluting stent in diabetics with single (3D study, sirolimus dose escalation) and multivessel disease (FREEDOM trial; CABG versus sirolimus-eluting stent) will provide a better understanding of drug and dose-response effects in a larger series of patients in comparison with present revascularization therapies. Similar trials must be conducted with other agents, such as paclitaxel. Ultimately, a combination of systemic (i.e., glycoprotein IIb/IIIa inhibitors, thiazolidinediones, angiopeptin, or other) and local therapy with drug-eluting stent may prove more effective by targeting the biological effects of hyperglycemia or insulin as well as local device biocompatibility. Otherwise, the tried-and-true endovascular brachytherapy for failed stents or surgical revascularization may prevail as the preferred revascularization strategies in the diabetic population with symptomatic coronary artery disease.