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Unless you’ve been living under a rock, you likely saw the New England Journal of Medicine paper last fall on the SAMMPRIS trial in which aggressive medical treatment beat intracranial stenting for patients with intracranial artery stenosis (N. Engl. J. Med. 2011;365:993-1003).
I’ve sent my share of patients for stenting. I’m sure you have, too. Sometimes, it’s even been against my better judgment. Patients (and doctors) often are infatuated with high-tech procedures, so when they come to me demanding a referral for such, it’s hard to refuse. Doing so runs the risk of losing a referral source.
Neurology, by nature, is a very tech-dependent field. We live by MRI, EEG, EMG/NCV [electromyography and nerve conduction velocity], and a bunch of other alphabet soups. Human nature leads us to believe that more expensive/invasive/high-tech treatments are better, compared with "take an aspirin and call me in the morning."
I have the highest respect for my colleagues in neurosurgery and interventional radiology. They often do incredible things.
However, technology isn’t always the best answer, even though it’s certainly the flashiest. Since 2004 the Wingspan intracranial stent has been available in the United States for humanitarian cases (people who had failed all other reasonable treatments). But in March 2012, an FDA advisory panel seriously questioned the device after the SAMMPRIS study was stopped prematurely. The fancy stent had a 14.7% incidence of death and early recurrent stroke (within 30 days of use), compared with 5.8% with boring old pills.
Cardiac disease treatments often lead to cerebrovascular treatments because of the similarities between the two systems. But that isn’t always the case. The combination of clopidogrel (Plavix) plus aspirin is routinely used in cardiology and, for many years, in neurology. But, as time has gone by, we’ve found this practice has no benefit, and greater risks, in stroke prevention. So it’s falling by the wayside.
Perhaps the best lesson to learn from this applies to all areas of life: bigger, newer, and more expensive doesn’t always mean better and can sometimes mean quite the opposite.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. He has been a practicing neurologist since 1998 and in private practice since 2000.
Unless you’ve been living under a rock, you likely saw the New England Journal of Medicine paper last fall on the SAMMPRIS trial in which aggressive medical treatment beat intracranial stenting for patients with intracranial artery stenosis (N. Engl. J. Med. 2011;365:993-1003).
I’ve sent my share of patients for stenting. I’m sure you have, too. Sometimes, it’s even been against my better judgment. Patients (and doctors) often are infatuated with high-tech procedures, so when they come to me demanding a referral for such, it’s hard to refuse. Doing so runs the risk of losing a referral source.
Neurology, by nature, is a very tech-dependent field. We live by MRI, EEG, EMG/NCV [electromyography and nerve conduction velocity], and a bunch of other alphabet soups. Human nature leads us to believe that more expensive/invasive/high-tech treatments are better, compared with "take an aspirin and call me in the morning."
I have the highest respect for my colleagues in neurosurgery and interventional radiology. They often do incredible things.
However, technology isn’t always the best answer, even though it’s certainly the flashiest. Since 2004 the Wingspan intracranial stent has been available in the United States for humanitarian cases (people who had failed all other reasonable treatments). But in March 2012, an FDA advisory panel seriously questioned the device after the SAMMPRIS study was stopped prematurely. The fancy stent had a 14.7% incidence of death and early recurrent stroke (within 30 days of use), compared with 5.8% with boring old pills.
Cardiac disease treatments often lead to cerebrovascular treatments because of the similarities between the two systems. But that isn’t always the case. The combination of clopidogrel (Plavix) plus aspirin is routinely used in cardiology and, for many years, in neurology. But, as time has gone by, we’ve found this practice has no benefit, and greater risks, in stroke prevention. So it’s falling by the wayside.
Perhaps the best lesson to learn from this applies to all areas of life: bigger, newer, and more expensive doesn’t always mean better and can sometimes mean quite the opposite.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. He has been a practicing neurologist since 1998 and in private practice since 2000.
Unless you’ve been living under a rock, you likely saw the New England Journal of Medicine paper last fall on the SAMMPRIS trial in which aggressive medical treatment beat intracranial stenting for patients with intracranial artery stenosis (N. Engl. J. Med. 2011;365:993-1003).
I’ve sent my share of patients for stenting. I’m sure you have, too. Sometimes, it’s even been against my better judgment. Patients (and doctors) often are infatuated with high-tech procedures, so when they come to me demanding a referral for such, it’s hard to refuse. Doing so runs the risk of losing a referral source.
Neurology, by nature, is a very tech-dependent field. We live by MRI, EEG, EMG/NCV [electromyography and nerve conduction velocity], and a bunch of other alphabet soups. Human nature leads us to believe that more expensive/invasive/high-tech treatments are better, compared with "take an aspirin and call me in the morning."
I have the highest respect for my colleagues in neurosurgery and interventional radiology. They often do incredible things.
However, technology isn’t always the best answer, even though it’s certainly the flashiest. Since 2004 the Wingspan intracranial stent has been available in the United States for humanitarian cases (people who had failed all other reasonable treatments). But in March 2012, an FDA advisory panel seriously questioned the device after the SAMMPRIS study was stopped prematurely. The fancy stent had a 14.7% incidence of death and early recurrent stroke (within 30 days of use), compared with 5.8% with boring old pills.
Cardiac disease treatments often lead to cerebrovascular treatments because of the similarities between the two systems. But that isn’t always the case. The combination of clopidogrel (Plavix) plus aspirin is routinely used in cardiology and, for many years, in neurology. But, as time has gone by, we’ve found this practice has no benefit, and greater risks, in stroke prevention. So it’s falling by the wayside.
Perhaps the best lesson to learn from this applies to all areas of life: bigger, newer, and more expensive doesn’t always mean better and can sometimes mean quite the opposite.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. He has been a practicing neurologist since 1998 and in private practice since 2000.