I’ve written a lot about Fractional Flow Reserve, or FFR, in the past — and the fact that it’s a simple tool that can be used during an angiogram to assess the actual obstruction to the volume of blood flow being caused by an arterial blockage. Sure you can SEE a blockage on the fluoroscopic image, but should you stent it?
The results of the by now well-known FAME study indicate that a third of the blockages between 50% and 90% (as seen on the angiogram) actually had an FFR measurement of greater than 80% (meaning that the obstruction of flow was less than 20%, even though the blockage looked more significant on the angiogram). Most importantly, treating those blockages with angioplasty and stenting resulted in worse outcomes at one year — results which have remained constant now three years later. For more information, read our exclusive interview with Dr. Nico Pijls, co-principal investigator for FAME. Continue reading
FAMEous interventional cardiologist William Fearon of Stanford sat down with Angioplasty.Org recently to talk about a better way to judge if a patient might benefit from a stent. Instead of looking at the x-ray angiogram and saying, “That’s a 70% blockage — let’s put a stent in there and you’ll feel much better,” Dr. Fearon advocates the use of a thin pressure wire which actually measures the flow through the narrowing. The technology is called Fractional Flow Reserve or FFR.
Turns out that sometimes what looks like a blockage on the x-ray isn’t always restricting the flow enough to cause ischemia (reduced oxygen to the heart muscle which usually, but not always, results in angina). And vice-versa, sometimes ischemia/angina is being caused by an area that doesn’t look so bad on the angiogram. Continue reading
I wrote about this issue over a month ago (see “To Stent or Not to Stent: That is the Question!“) but today’s newspapers are filled once again with the sad story of Maryland cardiologist Dr. Mark Midei, St. Joseph’s Medical Center and the alleged hundreds of unnecessary stents placed in patients who didn’t need them. This sudden renewed interest comes as the Senate investigational report by Senators Baucus and Grassley into this matter was made available — and into the mix of the story was added a pig roast, the Philadelphia mob, Abbott Vascular’s celebration of Midei implanting 30 of their stents in a single day and an email from a company executive, suggesting that someone take a Baltimore Sun reporter outside and “kick his ass!” Continue reading