Colin Rose is correct that in coronary disease, angioplasty and stenting address an acute disease state but in some trials do not affect overall progression and mortality. Give him credit for being a cardiologist!
It has been shown, however, that the endovascular approach offers a major improvement over the traditional surgery and treatment options previously available -- and of course is a much better option than death in an acute setting.
I respect each doctor and each patient and their extended family having the right to form an opinion based on their available best knowledge and their own specific situation -- risks, other treatments available, current state of disease and likely prognosis, and so on.
That said, Dr. Rose is entitled to his view, and yes, cardiologists know that angioplasty does not change the progression of coronary disease. But the reason coronary disease progresses is not related to angioplasty or stenting; it is because of lifestyle, overall health of the coronary patient, genetic factors -- you may imagine a stereotype of a heart disease patient, but people can get hardening and narrowing of the arteries even if they're young, even if they're healthy, just because they have a family history of heart disease that progresses relentlessly.
So this lack of effect on overall disease does NOT mean that angioplasty doesn't work. It could still be a far better alternative than invasive surgery with a higher rate of complications and death.
And I would not base my opinion of angioplasty and the entire field of interventional radiology and vascular surgery solely on its applications in cadiology. Although you could, for instance, take a narrow subset of cardiology and look at the success of stents for aneurysms vs. invasive surgery:
"With an endovascular repair, the risk of dying during or soon after the procedure is lower than the risk from open surgery. For an endovascular repair, about 1 out of 10 people die during surgery or within 30 days after surgery.1 For an open surgery, about 4 to 6 out of 10 people die during surgery or within 30 days after surgery.1 But over time, this benefit for endovascular repair might disappear. After a couple of years after the repair, people who had open surgery may live as long as people who had endovascular surgery."
Summing up, over the long-term, stent vs. surgery outcome appears the same in those who survive the initial intervention. But *significantly* more people survive stenting vs. surgery (10 percent death rate vs 40 to 60 percent death rate).
Now . . . we have said before that we can't compare people who have multiple sclerosis with people who have coronary disease. So angioplasty itself remains a straightforward procedure -- but what we are curious about is what happens when you do angioplasty on people who have venous malformations who also meet the diagnostic criteria for multiple sclerosis.
And then, separately in my opinion, is the question of what happens when you use stents in the population of people who have venous malformations and who meet the diagnostic criteria for multiple sclerosis.
For many people, a clinical trial is a rational approach. For some people, assessing their own specific risks and disease progression and treatment options, moving forward right now with the best practices we now know of is a rational choice. For many people, waiting for more information is a rational choice while they wait to see how the evidence turns out.
I have to agree that the term "CCSVI believers" is problematic because it implies that a person has made a faith-based decision instead of a rational conclusion based on research and professional medical advice.
And yes, there are people who go overboard in their acceptance of CCSVI and rationalize every possible issue with it. Yes, there are people who go overboard in their attacks on CCSVI and their refusal to accept any possible merit in the concept.
But the majority of people we can thank and respect here -- and MOST ESPECIALLY the physicians, s well as the pioneers and early adopters, the people who have personally experienced the good and the bad, many of whom are at a crisis point in their disease -- these are the people who are looking for genuine information and research and are not trying to polarize anyone already dealing with a truly miserable disease.
I will personally leave Dr. Rose to worry about cardiology, and I will express yet again my incredible gratitude to the people who have taken a chance on trying to investigate anything that could help with this crappy disease. I am not fervent one way or another about any particular approach -- I am passionate about helping each other and about telling people, truthfully, what has worked and what hasn't for me and for people I know and respect.
Roll a mile in their chair before you think you know anything about a person and their decisions and their thought process!
OH NO! RANTING ALREADY AND IT'S ONLY 10 AM!
Someone give me some decent coffee . . .