Re: [asa] occluders and stents

Well I am a neurologist and I vote with the neurologist that saw you, along with my cardiologist friend.

There is some evidence that PFO closure helps with migraine headaches though, so if you had a problem with those before you should be better now.
  ----- Original Message -----
  From: Randy Isaac
  To: asa@calvin.edu
  Sent: Sunday, July 01, 2007 10:49 AM
  Subject: Re: [asa] occluders and stents

  How true. It seems the head of interventional cardiology at MGH was so enthusiastic about inserting occluders that MGH formed a committee of 3 doctors who had to approve each case. Of course, each doctor has to have an office visit with each patient which slows down the process and keeps the cash registers clinking. It was amazing how differently each doctor approached it:

  interventional cardiologist: normal stroke rates are 1-2%/yr; with a PFO it is 4%/yr; with an occluder it's back below 2%; ergo, insert the occluder

  neurologist: no cause and effect has been established between strokes and PFO's. Occurrence of PFO's in the general population is 25-30% but in those with strokes it's 45%. Not enough data to justify an occluder.

  hematologist: oh, you've got three indicators of a genetic disposition to strokes that just exceeded the normal limits. Therefore you have a high risk of stroke, therefore you need the occluder.

  Hence, I had 2 out of 3 votes. Wow, what a process. All of them bemoaned the difficulty of recruiting participants in double blind, randomized studies. Few want to take the chance of not getting the occluder since it is seen as having no down-side and possibly a significant benefit, both physically and psychologically.

  Randy
    ----- Original Message -----
    From: Jack
    To: Randy Isaac ; asa@calvin.edu
    Sent: Sunday, July 01, 2007 7:34 AM
    Subject: Re: [asa] occluders and stents

    You are correct about the difficulty of obtaining good data on medical procedures.

    As nifty as the septal occluder is, a cardiologist friend of mine calls it a "device in search of an indication."

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Received on Sun Jul 1 22:16:18 2007