As a contribution to the controversial discussion for the use of drug-eluting stents, the European Heart Institute of the European Academy of Sciences and Arts is emphasizing important factors: a) drug eluting stents (DES) should be used only in accordance with their on-label indications for use; b) to avoid off-label use of DES and to assure that patients are apprized of all their revascularization options, patients should have informed consent between the patient, interventionist and a cardiac surgeon; c) without informed consent, off-label use of DES may be considered a legal offence against the interventionist; d) at onset of new symptoms, patients must be informed that surgery is a viable and recommended option.