Absolutely mister Fogdweller sir. I recall when I was 15, on my own and working with some old salts, Vietnam vets, crazy but fun bunch the lot of them, learning new construction and remodeling (plumbing), old Rick would tell me I better ask a question before going headlong and making a mistake. Great bunch too, even a Green Beret in there, teaching the kid the ropes. I do likewise now with my apprentices in the pipefitting field, though admittedly the "old way" of doing things is gone. Kinder, gentler, more talk and zero abuse haha.
Oh yeah the stents. ( I try to always digress).
Yes, I agree with your assessments completely, and this is something that I think the newbies and oldbies alike should always keep in mind, that everyone is going to present a unique and different situation, with hundreds of different combos and variations. No one solution is going to be applicable to all, and some may just plain old not work. Some stenoses are definitely amenable to angioplasty, no doubt about it. Some aren't. The re-stenosis is actually encouraging (bright spot!), as it correlates directly to the people who relapsed, and the ones that didn't, didn't relapse. Don't get no better than that!
This is why I keep going back to Simka, he appears to have the best of both worlds, insofar as we are able to assess at this point. Angio plus limited stenting, very small stents in areas that are not privvy to dislodging. (Far as we know). Now that's making assumptions of what we know and do not know on Dr. Simka's patients and their outcomes, barring an official release of some matrix or paper and such, so will leave it where it is, an assumption, for now. Subject to revision of course.
Yes there may HAVE to be some full blown surgical options considered in extreme cases, but myself, if I were in that position, I would assess my condition, and proceed with the least aggressive treatment first, then as warranted, start considering more radical options like open neck surgery. I know, easy for me to say. My sense also, is that by the time the stent has dissolved, even in a cramped area, the bone would have already dissolved to make way. Bone's are good like that, they don't like pressure and will adapt and adjust. I'll reiterate my orthodontics analogy, because it is very important in my opinion, teeth are bones. Those bones that are your teeth don't move, at least when they forcibly abut each other. They dissolve on the front, and add bone to the back. That's how braces work. Your teeth don't move, they dissolve! When the movement is not enough, we go back and get adjusted, i.e. the orthodontist tightens up our wire, that puts more pressure on, the process continues.
Teeth move through the use of force. The force applied by the archwire pushes the tooth in a particular direction and a stress is created within the periodontal ligament. The modification of the periodontal blood supply determines a biological response which leads to bone remodeling, where bone is created on one side by osteoblast cells and resorbed on the other side by osteoclasts.
Two different kinds of bone resorption are possible. Direct resorption, starting from the lining cells of the alveolar bone, and indirect or retrograde resorption, where osteoclasts start their activity in the neighbour bone marrow. Indirect resorption takes place when the periodontal ligament has become (necrosis or hyalinization), for an excessive amount and duration of compressive stress. In this case the quantity of bone resorbed is larger than the quantity of newly formed bone (negative balance). Bone resorption only occurs in the compressed periodontal ligament. Another important phenomenon associated with tooth movement is bone deposition. Bone deposition occurs in the distracted periodontal ligament. Without bone deposition, the tooth will loosen and voids will occur distal to the direction of tooth movement.
A tooth will usually move about a millimeter per month during orthodontic movement, but there is high individual variability. Orthodontic mechanics can vary in efficiency, which partly explains the wide range of response to orthodontic treatment.
Did ya catch that? 1 mm per month roughly. Of course that is with much greater pressure than what I think would occur with a stent, but is very conceivable in my mind that the stent would exert enough pressure, to dissolve bone, assuming it's not an extreme amount of protrusion.
Also, what if someone were to say (in extreme cases), get a dissolvable stent put into a fairly cramped space. The stent exerts enough pressure to open the vein for the time being, and at some point, dissolves, but during that time, x amount of bone is dissolved, creating more space. Now you come in with another stent, same idea, and that one does the same thing, but is making even more room during the (however long) it is there. So on so forth.
Just a thought, rambling, incoherent, you know, just me. hahaha.
Great discussion btw, thanks to E1 for all the contributions.
RRMS Dx'd 2007, first episode 2004. Bilateral stent placement, 3 on left, 1 stent on right, at Stanford August 2009. Watch my operation video: http://www.youtube.com/watch?v=cwc6QlLVtko
, Virtually symptom free since, no relap