Donate Help Contact The AHA Sign In Home
American Heart Association
Stroke
Search: search_blue_button Advanced Search
Stroke. 2007;38:e68
Published online before print June 21, 2007, doi: 10.1161/STROKEAHA.107.489039
This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
38/8/e68    most recent
STROKEAHA.107.489039v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Reiter, M.
Right arrow Articles by Schillinger, M.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Reiter, M.
Right arrow Articles by Schillinger, M.
Related Collections
Right arrowRelated Article

(Stroke. 2007;38:e68.)
© 2007 American Heart Association, Inc.


Letters to the Editor

Response to the Letter by Froio and Biasi

Markus Reiter, MD

University Clinic for Radiology, Department of Angiography and Interventional Radiology, University Clinic for Internal Medicine II, Department of Angiology, Medical University of Vienna, Vienna, Austria

Martin Schillinger, MD

University Clinic for Internal Medicine II, Department of Angiology, Medical University of Vienna, Vienna, Austria

Response:

We have read with interest the comments of Drs Froio and Biasi, who discussed their findings of a significant relation between plaque echolucency and the risk of stroke in carotid artery stenting (CAS).1 They concluded that the discrepancy between their findings and our results, indicating no significant effect of plaque morphology on the outcome after CAS, based on the high training level of our institution.1,2 The effect of learning in CAS has also been demonstrated by our group and is of course a major predictor of neurological outcome.3 Paying attention to the competency of the physicians performing CAS has additionally been pointed out by the Italian Consensus Carotid Stenting/SPREAD group, whose members also participated in the ICAROS trial.4

Therefore, we agree completely that the learning curve in CAS is fundamental. However, the authors’ conclusion that our results are not representative for the "real world" because of the high experience of our interventionists has to be challenged. One could argue that to identify an independent predictor of outcome of any intervention, it is important to rule out a "human" factor caused by untrained physicians, which might influence the final results.

Nevertheless, because of the missing literature dealing with this point, we cannot rule out an effect of plaque morphology on treatment performed by inexperienced interventionists or in elderly patients. Additionally, it would be interesting to perform a randomized trial analyzing a potential benefit of plaque evaluation for the selection of brain protection devices.

Acknowledgments

Disclosures

None.

References

1. Biasi GM, Froio A, Diethrich EB, Deleo G, Galimberti S, Mingazzini P, Nicolaides AN, Griffin M, Raithel D, Reid DB, Valsecchi MG. Carotid plaque echolucency increases the risk of stroke in carotid stenting: the Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) study. Circulation. 2004; 110: 756–762.[Abstract/Free Full Text]

2. Reiter M, Bucek RA, Effenberger I, Boltuch J, Lang W, Ahmadi R, Minar E, Schillinger M. Plaque echolucency is not associated with the risk of stroke in carotid stenting. Stroke. 2006; 37: 2378–2380.[Abstract/Free Full Text]

3. Ahmadi R, Willfort A, Lang W, Schillinger M, Alt E, Gschwandtner ME, Haumer M, Maca T, Ehringer H, Minar E. Carotid artery stenting: effect of learning curve and intermediate-term morphological outcome. J Endovasc Ther. 2001; 8: 539–546.[CrossRef][Medline] [Order article via Infotrieve]

4. Cremonesi A, Setacci C, Bignamini A, Bolognese L, Briganti F, Di Sciascio G, Inzitari D, Lanza G, Lupattelli L, Mangiafico S, Pratesi C, Reimers B, Ricci S, de Donato G, Ugolotti U, Zaninelli A, Gensini GF. Carotid artery stenting: first consensus document of the ICCS-SPREAD Joint Committee. Stroke. 2006; 37: 2400–2409.[Abstract/Free Full Text]


Related Article:

Carotid Plaque Echolucency Predicts the Risk of Stroke in Carotid Stenting According to the Type of Brain Protection Device and the Learning Curve
Alberto Froio and Giorgio M. Biasi
Stroke 2007 38: e67. [Extract] [Full Text] [PDF]




This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
38/8/e68    most recent
STROKEAHA.107.489039v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Reiter, M.
Right arrow Articles by Schillinger, M.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Reiter, M.
Right arrow Articles by Schillinger, M.
Related Collections
Right arrowRelated Article