The multitude of actions and interacting components involved in inciting and sustaining myointimal hyperplasia and restenosis effectively precludes the use of a single type of intervention. No pharmacologic approach has been conclusively shown to prevent coronary restenosis after balloon angioplasty or graft restenosis after peripheral arterial bypass. Although no human studies have been performed to prevent restenosis with gene therapy, the animal data are compelling, and the local delivery of various inhibitory agents may represent a novel way of preventing restenosis in vascular beds subjected to endovascular or traditional open procedures. Until these modalities are proved effective, the treatment of vascular stenosis due to internal hyperplasia remains within the domain of the surgeon.