magoo wrote:I wonder what the different treatment is????? Any guesses?
No guesses really, but an observation in a recent internet excursion:
Vascular dissection and rupture have been reported as a direct consequence of balloon angioplasty and stent placement in several cases. The development of smaller stents to prevent these complications has been proposed, and de Rochemont, et al., recently investigated the safety and efficacy of undersized stents in treating high-grade symptomatic intracranial stenosis. In this prospective study, 18 patients, seven of whom had intracranial ICA atherosclerosis, were treated with an undersized stent that was 0.5 mm smaller in diameter than the vessel. The 30-day combined incidence of death and stroke was 6%, with one patient suffering a parenchymal hemorrhage. At 6 months, no ischemic symptoms had developed. Notably, no cases of vessel dissection or rupture occurred. These results indicate that purposefully undersized stents may be safe and effective in the treatment of high-grade symptomatic stenosis. In this study the authors emphasize that the goal of treatment is to restore adequate cerebral blood flow, not to restore vessel diameter completely. Furthermore, the rate of restenosis is believed to be associated with the degree of intimal damage produced by balloon dilation.[
4] Considering that an increase in luminal diameter has an exponential effect on flow rate, adequate revascularization can be achieved without complete angiographically confirmed resolution of the lesion."
Of course this is from the arterial side, but much of what was initially learned re vein/stenosis/stenting/angioplasty, had it's genesis in the exploration of treating stenosed arteries. I think we're all aware it's not a precise 1>1 relationship, one is the water that comes through the meter, the other is the rain gutter, but it still gives pause for reflection, on what happens to the internal lining of vessels when balloned, and might go a bit further to explain the 50% recurrence of the Zamboni cohort. It also supports the notion that endothelial health is an important factor here, damage the lining, increase the likelihood of stenosis. Whether by life choices or by angioplasty.
Just some food for thought.....http://www.medscape.com/viewarticle/498762_3