Thankfully, we’ve learned from our mistakes. Opening blocked vessels is useful in really only two general areas:
Heart attack, where the rule of thumb is to open the tightest blockage (we refer to it as the “infarct-related artery”) and leave the rest as is.
Symptomatic blockages such as the 99% plug that caused my patient his troubles. If, on the other hand, a person has no chest pain or breathing difficulty associated with the disease, we provide no benefit by uncorking it—even if the blockage is 100%.
Short term and intermediate term comparison of endarterectomy versus stenting for carotid artery stenosis: systematic review and meta-analysis of randomised controlled clinical trials — Meier et al. 340: c467 — BMJ
Conclusions Carotid endarterectomy was found to be superior to carotid artery stenting for short term outcomes but the difference was not significant for intermediate term outcomes; this difference was mainly driven by non-disabling stroke. Significantly fewer cranial nerve injuries and myocardial infarctions occurred with carotid artery stenting.
New-onset AF was associated with an 80% higher risk of 90-day mortality.
Long-Term Outcomes in Sweden.
BMS = bare metal stent
DES = drug eluting stent
SCAAR = Swedish Coronary Angiography and Angioplasty Registry.
Note the size of the study population combined with the follow up period. A 25% reduction in mortality was found in patients with drug eluding stents vs. plain metal stents.
The clinical review videos from the ACC website are quite good. Make these mandatory for your underwriting staff. They are short and very informative.