Recanalization Rates Can Be Misleading

To the Editor:We read with interest Rha and Saver’s1 review of relationships between recanalization and outcome and commend them on their comprehensive review of pertinent literature. However, we disagree with their main conclusion that recanalization may substitute for measurement of clinical outcome.The central finding that leads Rha and Saver1 to their conclusion is that those patients who recanalized fared better than those that did not. We contend that this conclusion is valid only if a fixed dose of agent was used and the groups were comparable at baseline. In nearly every cohort there will be individuals that do not respond to a specific therapy regardless of dose and so are subject primarily to the toxicity of the intervention as dose is raised …