Dear Readers, This issue of the Journal of Invasive Cardiology includes original research articles, case reports, case reports with brief literature reviews, articles from the Journal special sections "Practice Management and Economics", and "Acute Coronary Syndromes", a CME Offering, as well as the summary of the discussion on Medical-Industry Relations that occurred during the 7th Biennial International Andreas Gruentzig Society Meeting held in St. Lucia. In the first original research article, Dr. Raisuke Iijima and associates Toho University and Mitsui Memorial Hospital in Tokyo, Japan, present their research on the impact of cutting balloon angioplasty in the treatment of diffuse in-stent restenosis. In comparison to balloon angioplasty the authors observed a non-statistically different recurrence rate comparing cutting balloon and balloon angioplasty lesions, but noted that lesion that re-recurred were significantly shorter in the cutting balloon group. The second original research study, submitted by Dr. Hisataka Sasao and colleagues from the Department of Cardiology at the Hakodate Goryoukaku Hospital in Goryoukaku Hakodate, Japan, compares the 3-year clinical outcome between the Multi-Link and Palmaz-Schatz stents in Japanese patients treated for coronary disease. Their study demonstrated that the two stents performed equally well at 3-years, with very similar clinical outcomes. In the third original research article, submitted by Drs. Ashraf Nagm and John Moore from the Heart Center for Children at St. Christopher’s Hospital for Children, Drexel University College of Medicine in Philadelphia, Pennsylvania, describes their technique for determining proper stent size for implantation in pulmonary branch stenoses using a compliant sizing balloon. The last original research article, from Dr. Peter Ruygrok and associates on behalf of the PHARAO investigators, explored the feasibility of using aspirin and heparin-coated stents as the primary treatment regimen for coronary disease patients. They found that at 1-month follow-up no major adverse cardiovascular events had occurred, suggesting that this combination therapy is effective and merits further large-scale investigation. Dr. Joseph P. Carrozza from Beth Israel Deaconess Medical Center in Boston, Massachusetts, provides an accompanying commentary. This issue of the Journal also includes two case reports with brief reviews of the literature and several other case reports. In the first case with a review of the literature, Drs. Quintal, Nguyen and Glancy from the Sections of Cardiology and Departments of Medicine at Touro Infirmary and Louisiana State University Health Sciences Center and The Medical Center of Louisiana Foundation in New Orleans, Louisiana describe their approach to angioplasty of a ramus intermedius branch through a solitary coronary ostium. In the second case report and brief review, Drs. Briguori, Di Mario and Colombo from the Vita – Salute University School of Medicine, San Raffaele Hospital and EMO Centro Cuore Colombus in Milan, Italy demonstrate their use of distal embolization protection during directional coronary atherectomy. In the first case report, Dr. JoAn Monaco and colleagues from the University of Kansas School of Medicine and Mid-America Cardiology Associates in Kansas City, Missouri report a case in which deep musculocutaneous radiation injury requiring local debridement and surgical reconstruction occurred following a prolonged PCI procedure. They discuss the frequency of this type of injury and methods to reduce its occurrence. In the next case report, Drs. Konig, Stempfle and Klauss from the Department of Cardiology, Medizinische Klinik – Innnenstadt, University Hospital in Munich, Germany describe their approach to accurately placing a PTFE-covered stent using intracoronary ultrasound guidance to successfully treat a complex coronary aneurysm. In the last case report, Drs. Bertrand, Larochelliere and Tessier from the Interventional Cardiology Laboratories and Nuclear Medicine Department at the Quebec Heart-Lung Institute/Laval Hospital in Quebec, Canada present an unusual situation in which the trans-radial approach was used to deliver brachytherapy to 3 different coronary vessels during a single session. This issue also includes selections from 2 of the special Journal sections. In the first special section, "Practice Management and Economics", edited by Dr. Ron Riner of the Riner Consulting Group in St. Louis, Missouri, Jason Cummings and Dr. Riner have written an informative piece on the importance for physician practices to define their healthcare market as a critical first step in developing a strategic plan. They offer guidance in defining what a market is and how this can best be done. In the "Acute Coronary Syndrome" special section, edited by Dr. Lloyd Klein from the Department of Cardiology at Rush Presbyterian Medical Center in Chicago, Dr. Klein has invited Drs. Shimpi, Mahaffey and Tcheng from the Duke Clinical Research Institute in Durham, North Carolina to provide a review of the use of low-molecular-weight heparin and glycoprotein IIb/IIIa inhibitors with PCI used in the treatment of acute coronary syndromes. In this issue, we also publish the last in a series of discussions that occurred at the 7th Biennial International Andreas Gruentzig Society Meeting held in St. Lucia last year. This discussion represents one of the most unique aspects of this meeting, which brings together physician thought leaders and prominent people in industry to grapple with the most critical issues facing cardiovascular medicine today and what innovations may emerge in the future to address these challenges. I am sure that you will find this discussion informative and thought provoking. This issue of the Journal is completed with a special CME Offering, provided by Dr. Ricardo Costa and colleagues from the Institut de Cardiologie de Montréal in Quebec, Canada. In this article, the authors present 5 cases of radiation therapy in bifurcation in-stent restenotic lesions using an intraluminal beta radiation catheter delivery system called the Novoste™ Beta-Cath™ System. They find that performing beta radiation using this system appears to be safe in in-stent restenotic bifurcation lesions. It is my hope that the articles in this issue of the journal provide cardiovascular specialists with new perspectives for meeting the challenges they face in the daily treatment of patients with cardiovascular disease.