Benestent II, a remake of Benestent I? Or a step towards the era of stentoplasty?

Star Wars II, Alien III and Rocky IV failed to arouse enthusiasm among moviegoers who had unconditionally appreciated the ‘seminal’ version of these famous movies. . . . However, Benestent II is neither a remake nor the continuing story of Benestent I. In 1990–91, some prominent European cardiologists, solicited for their collaboration, refused to participate in Benestent I for ethical reasons; stents were potentially dangerous and expensive devices necessitating complex anticoagulation and long hospitalization. These ‘refusers’ did not subscribe to the motto of Andreas Gruentzig ‘if in doubt, let us randomize’. In their minds, stents were undoubtedly worse than balloons. In 1994, after the publication of Benestent I in the New England Journal of Medicine, it was difficult to restrain the enthusiasm of investigators who wanted to be part of the Benestent II study. In the meantime the stent has proven to be superior to the balloon. In 1998 the medical community may have been tempted to see Benestent II as just a plain and self-evident confirmation of Benestent I. Today a ‘BS lesion’ (Benestent–Stress type of lesion) has an almost negative connotation and refers to a simple, easy to treat lesion almost never seen in the real world of clinical practice. Beyond these psychological and rather superficial considerations, the practitioner may have overlooked a few essential facts emerging from the Benestent II trial, which will influence our future practice. Fact number 1: in Benestent II, we were not treating ‘BS’ lesions in ‘BS’ patients. In Benestent II, 55% of lesions were in AHA/ACC class B2 or C; 45% of the patients were unstable and 32% were in Braunwald