Monthly Archives: December 2011

Boston Scientific’s New Drug-Eluting Stent in the News Again

Boston Scientific's Element Stent vs. Medtronic's Integrity

Which stent platform do you think compresses more easily: Boston Scientific’s Element (top) or Medtronic’s Integrity (bottom)?

I first heard concerns about stent deformation, primarily seen in the PROMUS Element stent made by Boston Scientific (NYSE: BSX), during a presentation at a small interventional meeting last summer. The issue was then reported in two journal articles, just prior to the TCT meeting in November, where it became a topic of much attention — although most interventional cardiologists felt that it was nothing like the problem of late stent thrombosis, first seen as a “rare” event in the first generation of drug-eluting stents five years ago. Continue reading

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Filed under FDA, Stent

A Stent By Any Other Name

Stent and RoseForgive the perverse Shakespearean pun in the title but, as the Bard wrote: “What’s in a name? That which we call a rose by any other name would smell as sweet.” My topic is pretty much the polar opposite of roses, but the whole concept of labels and what we call things has become increasingly important. It’s one that I touched on in my post over last weekend about the impending CMS audits of stent procedures: namely, that the “official” terms used to describe treatment of a blocked artery are flawed when it comes to proper use of the English language.

The official “Appropriate Use Guidelines” place stent and angioplasty procedures into three categories: Appropriate, Uncertain and Inappropriate. Any patient, potential patient or, for that matter, anyone not steeped in the minutiae of interventional cardiology, would look at those terms and assume that any doctor putting a metal coil into someone’s heart when the procedure was labeled “uncertain” or “inappropriate” should be fined or fired or both. Continue reading

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Filed under Appropriate Use Criteria (AUC), COURAGE, Media Coverage, Stent

Stents, Angioplasty and PCI: The Uncertainty Principle (MEDICARE Style)

Is This Stent Necessary?The question of the day, regarding whether or not to stent a coronary artery, is now being brought to the forefront by the U.S. government in the form of a Medicare “Demonstration Project”. And by “brought to the forefront”, I mean MONEY! — as in “we won’t pay you if we determine that the stent procedure was inappropriate.”

The bottom line is that, on November 15, CMS announced “New Demonstrations to Help Curb Improper Medicare, Medicaid Payments“. These so-called “demonstrations” will occur in 11 states where claims “historically result in high rates of improper payments”: Florida, California, Michigan, Texas, New York, Louisiana, Illinois, Pennsylvania, Ohio, North Carolina and Missouri. Continue reading

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Filed under Appropriate Use Criteria (AUC), Cost Effectiveness, Health Insurance, Media Coverage

Women’s Heart Disease and Intravascular Ultrasound (IVUS)

Dr. Habib Samady of Emory in Atlanta at IVUS console

Dr. Habib Samady of Emory in Atlanta at IVUS console

I’ve written before about the use of IVUS in stent and angioplasty procedures in women, most recently in October about a study done at NYU Medical Center. My article, “Intravascular Ultrasound (IVUS) Imaging Reveals Hidden Heart Attack Culprit In Women“, showed how intravascular imaging could detect a type of coronary disease not seen on angiography.

Now a similar tale has been broadcast by CBS affiliate WGCL-TV in Atlanta about how a type of coronary narrowing more typical in women may not be seen on a standard angiogram because it’s evenly distributed along the arterial wall or channel and doesn’t appear as a “spike” or sudden narrowing — yet it may be restricting the flow of blood to the heart just the same. Once again — angiography alone is not enough to accurately diagnose coronary artery disease and guide its treatment. Continue reading

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Filed under IVUS, Media Coverage

Stent as Concertina

A "Stent Concertina"Call it an accordian, a concertina or a “squeezebox”…but don’t call it a stent. Because one thing that is not music to your ears is a coronary stent that you have carefully placed to relieve your patient’s symptoms — and which then gets shorter or longer when you push or pull another catheter, balloon or wire through it.

This is an issue that was first raised a little over a month ago and it has been the subject of a number of news articles. It’s been dubbed “the concertina effect” but its scientific name is “longitudinal stent compression” or “longitudinal stent distortion” and it’s of concern because once a stent has been correctly sized and placed in just the right position to keep a blockage open…well, you don’t want it moving or changing shape. Continue reading

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