Strokes are worrisome because they can not only be fatal but also result in permanent disability with paralysis, weakness or trouble communicating. Strokes can be caused by many different problems. This article discusses two of the causes of stroke and their treatment. The headline and both the beginning and end of the article discuss new methods for treating blood vessels in the brain that are weak and in danger of rupturing. The middle of the article details the technology used for treating blockages of the carotid arteries (which are vessels in the neck and not the brain). The article contains a lot of interesting information which is then confused by the “lumping” treatments for different conditions and inclusion of statistics that are not readily applicable to the conditions discussed . The pathology is different and so are the treatments. The last line in the article – “Sometimes, no treatment may be the best thing” – is an extremely difficult concept to convey yet it is germane to decisions regarding the use of the treatments described in the article. The story would have been much better if it had spent more time on this latter point – and on data to support any of the treatments described in the article.
The story never mentioned costs of any of the devices mentioned. Telling readers that Medicare was now reimbursing for some stents in some patients isn’t good enough. Someone (taxpayers) are paying for these devices. How much? Readers deserve to know.
The article explains that there have been studies (without telling us anything about the studies) that found that carotid stenting was equivalent to surgery in patients considered high risk for carotid endarterectomy but that it isn’t known how well they stack up for patients with a lower risk. For procedures in the brain, the article was clear that at this time, it is only considered appropriate for those who don’t respond to the standard medical treatment. However, the article failed to quantify risks and benefits. Good data may not be available for some very new devices such as the Wingspan, but data exist nonetheless. And data are available for other devices such as the coil/clip for aneurysm and for stent/surgery for blockages. The story should have provided these.
There was no information on the harms associated with either carotid stenting or the use of the Wingspan to treat blood vessels in the brain. Whenever you do something to carotid arteries or to the brain, bad things can happen. The story should have described what can go wrong.
The article does not provide different levels of evidence regarding the three different stroke situations discussed and new and old treatments. It did mention that there are not yet studies “comparing one therapy against one another in large numbers of randomly chosen patients.” However the article failed to give details on any of the data available to support any of the treatments discussed. A discussion of evidence – and quality of evidence – was totally lacking.
National statistics are provided for the number of strokes and mortality and a specific incidence (1%) and consequence (death) is mentioned for aneurysms. The article however discusses two different types of strokes and their prevention: aneurysms with coils and clips and athersclerotic plaques with stents or surgery. The story confuses readers because it goes from discussion of stents and strokes in the middle to the profiled patient’s problem which is an aneurysm. The story should have spent more time on the uncertainty of new devices without clear evidence and also the uncertainty of physicians and of patients about what would be the best treatment options. “Lumping” different cerebrovascular events – and their treatments – together and confusing them amounts to disease mongering.
Although sources from different institutions were quoted, there was no mention of any financial ties that might exist between these clinicians and the manufacturers of the medical devices.
The article mentions other surgical approaches used for treating vessels in the brain as well as the procedure for blocked carotid arteries.
While the story mentions that Medicare will now reimburse for some carotid stent use in some patients, it never explains if the new Wingspan stent is approved by the FDA. Readers should be told.
There is an FDA approved medical device that uses stents and coils to treat blood vessels in the brain in danger of rupture. The way the article described the Buffalo team “studying” and “adapting” and that “the science isn’t there yet” makes it sound like this technology is new, even though it has been approved since 2003. Describing the Wingspan stent as “superelastic nickel and titanium alloy called nitinol, which can curve and taper to navigate the brain’s smaller, tortuous vessels” doesn’t tell readers what they really need to know: how novel is this new idea and what data exist to support the idea?
Because sources were quoted from different institutions, it does not appear that the story relied solely or largely on a news release.