Robust macros allow you to create domain-specific abstractions. That's cool, but there are plenty of other ways. Even functions are a way to create abstractions. And with anonymous functions, you can easily create higher-order abstractions.

The only thing AST-level macros help with is creating custom syntax to cut down on boilerplate. That's very cool, but it comes with a cost: now you have to learn new syntax.

I love Lisp. I've written tiny Lisp interpreters for most of my games (Chron X, Transcendence) and even GridWhale started out with a Lisp-like language.

In my experience, Lisp is great when you have a single programmer who understands and controls the whole source tree. Once a program exceeds the capacity of a single programmer, more conventional languages work better.