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January 12, 2007 -- 7:55pm ET "I can see clearly now" -- IVUS and Thrombosis Yesterday that idea got the imprimatur of a major professional organization: the Society for Cardiovascular Angiography and Interventions (SCAI). In the SCAI's official journal, Catheterization and Cardiovascular Interventions, a distinguished team of cardiologists (a.k.a. the SCAI Drug-Eluting Stent Task Force) offered a series of practical recommendations for cardiologists about reducing the risks for late stent thrombosis. It was titled "Clinical Alert on Late Stent Thrombosis" and a PDF of the full SCAI article can be found here. My favorite recommendation was "the importance of...meticulous stent implantation." I read it and thought to myself, "I knew it! All along I've had this sneaking suspicion that so much of this thrombosis problem is due to that darn 'unmeticulous' technique." "Meticulous" was the word-of-choice for the press release; the actual article uses the adjective "careful". I feel, however, that "meticulous" is more accurate. It's not that interventional cardiologists are not careful (i.e. "full of care") when they incorrectly place a stent. It's just that they can't see it well enough because, according to the recent J&J/Cordis-sponsored STLLR study of 1,500 patients, this happens 66.5% of the time! Hold on. Did I misread that? You mean your chances are only 1 in 3 of getting a stent implanted "meticulously"? As Scott Huennekens, President and CEO of Volcano Corporation, one of the only two IVUS manufacturers, commented yesterday to the JP Morgan Healthcare conference:
IVUS might cut that figure way down because it allows the cardiologist to look at the artery from the inside out. For example, if a stent has not been fully expanded, this might not be evident using the current "gold standard" of angiography, but IVUS would show this clearly. IVUS technology was invented well over over a decade ago (I know because I produced some of the first training videos about IVUS for cardiologists) yet today in the year 2007, only 12% of stent procedures use IVUS. I think that this is going to change significantly, due in great part to the concerns about late stent thrombosis (again, read our feature on the connection between thrombosis and incorrect stent placement). Recently, highly-respected thought-leader and interventional pioneer Dr. Antonio Colombo of Milan has announced that he is now going to use IVUS in every case he does. Suffice to say, this is an imaging technology that is going to become much more important in the very near future. |
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