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Stent vs. scalpel

Rating

3 Star

Stent vs. scalpel

Our Review Summary

This story reports on carotid stenting as a possible alternative to endarterectomy. By framing it as stent vs. surgery, it assumes, however, that intervention needs to be done. While the evidence supports intervention for patients with symptoms of stroke, it is much less clear for patients who have carotid stenosis but no symptoms. By presenting the medical turf battle over ownership of this procedure, it provides some insight regarding the possibility of untoward enthusiasm for this intervention. The risk of stroke or death one year after stenting or surgery is presented as comparable at 10%. No comparison of risks was given for the use of blood-thinning or blood pressure drugs. In fact, non-surgical approaches (drugs or watchful waiting) received only a one-line mention in this story – almost as if they are out-moded ideas. Overall, the piece provided some context for following developments in this area of medicine.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

Cost of stenting procedure put at $10 -15K; later mention of

Medicare restriction of coverage criteria.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

Mentions 10% risk of stroke or death following stenting, though data source is not mentioned. Mentions side effects without

rates. Includes report from one patient of perceived benefit. Therefore incomplete.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

See above – the piece does not provide

absolute rates for harms or side effects for various treatment options.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

Does explain the weight placed on data from a randomized

clinical trial; careful read reveals that these data are not yet available. Not clear about the source of the data supporting

claim for comparable stroke and death rates for both stent and surgery. Does not make clear that the question about whether

or not to intervene really depends on whether the patient has stroke symptoms. If they have had a stroke or transient

ischemic attack, intervention is beneficial. The evidence for treating asymptomatic stenosis is much less clear.

Does the story commit disease-mongering?

Not Satisfactory

Provides natural history. While harboring an element of disease mongering in terms of stroke concern it also

contains a flavor of over-enthusiasm by physicians to intervene; mentions the element of competition among specialties for

this piece of the medical care pie. The framing of the story implies that the falls and “unwell” feeling were caused by the

patient’s carotid blockage, which may not really be the case.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

Good job pointing out medical turf battle over ownership of this procedure, and

industry sponsorship of symposium.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

Mentions endarterectomy having

comparable outcome; single mention of medical treatment with no mention of outcome; no data for watchful waiting. Therefore,

incomplete.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

Very clear presentation of FDA

approval of devices made by two manufacturers and that others are awaiting full approval.

Does the story establish the true novelty of the approach?

Satisfactory

Explains carotid stenting as

relatively new; piece later goes on to mention newer stenting systems with implanted filters

Total Score: 5 of 10 Satisfactory

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