Monthly Archives: October 2014

Fractional Flow Reserve and Ebola: Thresholds and Decision-Making

   This week started off with me watching a demonstration of fractional flow reserve (FFR) during multivessel PCI. This very instructive case was transmitted live from Hammersmith Hospital in London and featured Dr. Justin E. Davies showing how to perform FFR and, more importantly, how the use of FFR changed the treatment plan for this patient.

The angiogram had shown three intermediate blockages (LAD, OM, RCA) and, as such, this patient might have been a candidate for CABG instead of PCI. However, when FFR was used to measure whether or not these blockages were ischemic, two were found to be hemodynamically insignificant: it would be safe to defer stenting and treat them medically. The third lesion in the LAD clearly was the cause of the symptoms and stenting would have benefit for the patient. Continue reading

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Filed under Appropriate Use Criteria (AUC), FAME I / FAME II, FFR, Media Coverage, Stent, Video

AimRADIAL Masterclass Comes to Chicago

   On October 23-25, 2014 the 3rd Advanced International Masterclass on the Transradial Approach will be held in Chicago and, if you already perform or want to start using the wrist approach to diagnostic or interventional procedures, you need to attend. Where else will you be able to spend two-and-a-half days with the most expert and experienced radial practitioners in the world?

I went to the very successful AimRADIAL course in New York City last fall and witnessed something I hadn’t really seen since the early days of angioplasty: a relatively small meeting (i.e. less than 300) attended by the pioneers of the procedure, cardiologists who have the largest experience in the radial approach, talking among themselves and trading their latest findings and techniques with each other, and sharing this information with the newer generation of physicians in attendance.It felt like an actual community! Continue reading

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Filed under Global Trends, Innovators, Meetings & Conferences, Patient Experience, Transradial Approach

Will a Denial of Service DOS Attack Hit New York State Medicaid Patients? Or Perhaps Your State?

  What does a Denial of Service Attack have to do with stents, angioplasty and PCI?

In the world of computing, a DOS attack is defined as “an attempt to make a machine or network resource unavailable to its intended users.” Typically netbots programmed by hackers overwhelm the web servers of banks, credit card providers, etc. whose sites then become unavailable to their customers. Now it seems similarly that in New York State, cardiovascular treatments may become unavailable to some Medicaid patients: a denial of service. Continue reading

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

FFR and iFR: Roadmapping Your Heart, “With Traffic”

The coronary angiogram is often referred to as a road map of the heart. As such, it serves the cardiologist and cardiac surgeon well. It shows where the coronary arteries are, how they intersect, the angles of the branches, etc. There are diagrams of these anatomical features in many textbooks, but the reality is that these characteristics can vary from individual to individual, so it’s necessary to get a road map for each individual in whom an intervention is being contemplated.  Then, of course, there’s the issue of narrowings in the coronary arteries. Should these receive stents? Should they be bypassed? Should they be left alone and treated with medical therapy? Continue reading


Filed under Angiograms, FAME I / FAME II, FFR, Heart Attack, Imaging, Stent