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Fractional Flow Reserve and Intravascular Imaging on Stage at EuroPCR
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Palais des Congrès and Hotel Concord La Fayette
Palais des Congrès and Hotel Concord La Fayette
May 14, 2012 -- Interventional cardiology is usually associated with stents, balloons, catheters and an array of niche devices that can shave, vacuum, and compress the plaque or thrombus that blocks arteries, causes ischemia and heart attacks. But a relatively new and rapidly growing area in intervention is called Intravascular Imaging and Guidance. Ultrasound, lasers, and thin wires that measure flow velocity and blood pressure are increasingly being used by cardiologists -- first, to help decide whether or not to stent a coronary artery and second, to yield information that makes placing and sizing those stents more accurate and safer.

Starting tomorrow, the largest European meeting of interventional cardiologists begins in Paris, and for four days, physicians will be watching demonstrations, live cases and lectures about a wide range of technologies and techniques -- and Intravascular Imaging and Guidance will be a topic on many physician's minds, as more and more data is presented, demonstrating how these imaging modalities can make percutaneous coronary interventions (PCI) better.

Functional Measurement and Fractional Flow Reserve (FFR)
In particular, the field of Functional Measurement (FM) is being touted by the two major companies that make FM products: Volcano Corporation, based in San Diego, and St. Jude Medical, based in Minneapolis. The technology is called Fractional Flow Reserve (FFR) and in previous studies (DEFER, FAME) has been shown to be a more accurate method than angiography alone for determining whether or not a patient will benefit from opening a blocked artery. As part of the opening day at this year's EuroPCR, the preliminary results of FAME II will be presented. Enrollment in this trial, sponsored by St. Jude Medical, was prematurely ended when the Data Safety Monitoring Board concluded that it would be unethical to continue randomizing patients with FFR-measured ischemia to either Optimal Medical Therapy or PCI because those patients who did not get stented (PCI) were experiencing significantly higher rates of readmission and urgent revascularization. With the topic of "appropriateness of stenting" on everyone's minds these days, a technology that may be able to refine that decision-making process is being looked at with great interest.

Instant Wave-Free Ratio™ Functionality (iFR™)
A new type of FFR-like device will also be the subject of several presentations. Dr. Justin E. Davies of Imperial College London will be discussing the results of a multicenter registry, comparing an adenosine-free pressure-derived index, called Instant Wave-Free Ratio™ Functionality (iFR™), manufactured by Volcano Corporation. If the data from this device correlate to FFR readings, iFR will provide a faster and more patient-comfortable method of measuring intracoronary pressures.

Intravascular Ultrasound (IVUS), Optical Coherence Tomography (OCT), Near InfraRed Spectroscopy (NIRS) and More
In addition to devices that help decision-making pre-procedure, intravascular imaging modalities are extremely useful in sizing and placing stents: to make sure the diameter and lengths chosen are appropriate, and to make sure that the stent completely covers the diseased area, something often not entirely visible using angiography alone. There are a range of such imaging devices that will be presented at EuroPCR.

Volcano's list of events can be found here; St. Jude Medical has listed its presentations here; and a new hybrid modality of IVUS and NIRS will also be presented -- more information can be found on the device-maker's InfraRedx website.

About the Intravascular Guidance Center on Angioplasty.Org
To assist in educating the professional and patient population in the U.S. about these new imaging, measurement and therapetic techniques, Angioplasty.Org created the "Intravascular Guidance Center" in 2006: a special section which is devoted to information and news for both patients and physicians about intravascular ultrasound (IVUS), fractional flow reserve (FFR), optical coherence tomography (OCT) and other intravascular modalities. The Intravascular Guidance Center features overview articles, the latest news and interviews with leading practitioners of these techniques, such as Drs. Antonio Colombo, John McBarron Hodgson, Augusto Pichard, William Fearon and Nico Pijls. This special section receives support from Volcano Corporation.


Reported by Burt Cohen, May 14, 2012