Terrific article. Please keep educating us! Living in a country where medical procedure utilization is often driven by provider reimbursement (see similar poor evidence for arthroscopy for meniscal tears), I have to smile at the medical communities’ refusal to accept the findings of the COURAGE trial. Science based are they? Ha!
Quality info Paddy. Do you think there is any merit in blood flow analysis in non-symptomatics?
Perhaps it might yield a more an accurate evaluation of the the relevance of visually observed obstruction?
As an aside my old man Dr Dermot Fitzgerald was instrumental in bringing Ultrasound to this country 50 years ago. Ironically he was ostracized by the surgical community for attempting to prevent amputation on the basis of blood flow dynamics rather than static imaging of obstruction. Little did I know that I'd be taking a more active interest in his life's work long after his passing!
I am really disappointed, confused and somewhat concerned by your article. You present research findings before dismissing each of the studies. You then provide anecdotal references to how you treat your own patients announcing that sometimes there are hard outcomes, including death from stenting. You make no attempt to illustrate the percentage risk involved or of the actual percentage of deaths that occurred. I think that your article is far below your usual excellent standards. I find your approach of watch this space for the next instalment to be insensitive to your readers. Why would you not wait until you had finished the full article and present same? I don’t believe that you would ever half brief a patient and then ask them to come back the following week and you will explain further!
Terrific article. Please keep educating us! Living in a country where medical procedure utilization is often driven by provider reimbursement (see similar poor evidence for arthroscopy for meniscal tears), I have to smile at the medical communities’ refusal to accept the findings of the COURAGE trial. Science based are they? Ha!
Quality info Paddy. Do you think there is any merit in blood flow analysis in non-symptomatics?
Perhaps it might yield a more an accurate evaluation of the the relevance of visually observed obstruction?
As an aside my old man Dr Dermot Fitzgerald was instrumental in bringing Ultrasound to this country 50 years ago. Ironically he was ostracized by the surgical community for attempting to prevent amputation on the basis of blood flow dynamics rather than static imaging of obstruction. Little did I know that I'd be taking a more active interest in his life's work long after his passing!
Really enjoy the posts Paddy
I am really disappointed, confused and somewhat concerned by your article. You present research findings before dismissing each of the studies. You then provide anecdotal references to how you treat your own patients announcing that sometimes there are hard outcomes, including death from stenting. You make no attempt to illustrate the percentage risk involved or of the actual percentage of deaths that occurred. I think that your article is far below your usual excellent standards. I find your approach of watch this space for the next instalment to be insensitive to your readers. Why would you not wait until you had finished the full article and present same? I don’t believe that you would ever half brief a patient and then ask them to come back the following week and you will explain further!
Very worthwhile article to read . There seems to be no clear answer to many questions . Festina lente !