I am still in search of a well reasoned argument
as to what the stock price will do in response to
the Nir approval. My common sense tells me that if it
is no surprise then it should already be priced in.
Honestly, will the approval catch anyone off guard? The
downward action over the past couple of days could be
evidence to support this. Why will people not sell on
I do not currently hold any position in
BSX although I have been toying with a Aug 80 call.
Most aneurysms are coiled because: A)The location
of the aneurysm is too difficult for the
neurosurgeon to clip or B)The patient is not a surgical
candidate, the risk of surgery out ways the risk of a
ruptured aneurysm. Just as in carotid stenosis, surgery
(endarderectomy) is the gold standard and will continue to be, but
in some cases it is necessary to try nonsurgical
interventions. GDC coiling is ahead of any covered cerebral
stenting by at least ten years.
agreed, but you are talking aortas vs
intracranial vessels. Orders of magnitue difference in size.
And to my knowledge..stent grafts are still in trial
here and not FDA approve. Aortic stent grafts have
such a large profile, they require surgical cut down
even to introduce. This is a far cry from the original
subject...intracranial stent grafts.
stents hold lumens
stent grafts hold lumen open and repair or ameliorate
defects in vessels....well kinda. Basically they just
provide an intraluminal "graft", just like a surgical
graft. They "bypass" the bad part of the artery and let
the body scar it down. If you need to repair an
artery (nonaneurysmal), say for dissection, a plain Jane
stent is just fine.
My thinking here is....you have a (one) guy that
put a stent in a carotid artery. Ok, the article did
not say it clotted it off..probably didn't. Stents
that are not covered will allow flow through. This is
not a medically proven treatment nor does it sound
like it will be for a LONG time..if ever. Sounds to me
like he had no other choice and gave it a try. What if
you stent a few aneurysms and you don't get
fibrosis/clot formation...FDA likely will not approve it as a
I also concur about the stent
being placed to hold coils in for wide mouthed
aneurysms. You go putting in coils and they fall out...but
VERY FEW intracranial aneurysm are wide mouthed. And I
think if you couln't intervene...the proven methology
(surgery) would be a better choice. Remeber, surgeons have
been treating these things for years with almost the
same complication rate, if not less than
As far as getting coils
throught the side wall of the stent..no problem..done it
before in the peripheral circulation many
BUT the kicker goes back to patency rates in blood
vessels in the PERIPHERAL circulation (not heart). 5mm or
less...100% occlusion rates rapidly with current technology
secondary to endothelial hyperplasia. That my change with
radiation implantation..which is coming, but slowly. You
are clearly placing that patient at risk for
Anyone want to bet the farm on one doc putting a stent
in with the hopes is will clot the aneurysm with
those kind of complications later.
I will give
it an..."interesting" I would like to know if he had
stent first because he couldn't coil it routinely.