At this week’s annual European Society of Cardiology Congress in Rome, an important randomized clinical trial on stents was presented by Professor Kaare H. Bønaa, MD, PhD of the Clinic for Heart Disease, St. Olav’s University Hospital in Trondheim, Norway. Called NORSTENT, short for the “Norwegian Coronary Stent Trial,” this was the largest stent trial ever conducted, with 9,013 patients followed for six years. That’s serious! Continue reading
Category Archives: Stent
If you’ve been wondering what iFR (Instant wave-Free Ratio) is, how it works, how it compares to FFR (Fractional Flow Reserve) and, most importantly, how it affects clinical outcomes, then click here to register for a free, online, interactive live case being done on Monday, April 13, 2:30pm-3:30pm London Time, 9:30am-10:30am New York Time).
Interactive: that means you can ask questions!
Dr. Justin E Davies, interventional cardiologist at Imperial College NHS Trust, and developer of iFR, will be performing and guiding the worldwide audience through a live complex PCI multivessel case, using physiology to guide his procedure. Continue reading
Almost two decades ago, interventional cardiology pioneer Dr. Spencer B. King III penned an article for Circulation titled, “Angioplasty From Bench to Bedside to Bench.” Dr. King’s article was a recounting of the history of the development of the angioplasty balloon catheter by his colleague at Emory University, Andreas Gruentzig.
This morning, the title of his article took on new meaning, as Supreme Court Justice Ruth Bader Ginsburg entered the courtroom and took her seat, engaging in several complex legal arguments concerning mortgage loan officers, Facebook threats, and more. Continue reading
“I don’t know how anyone can do these procedures without measuring pressures!”
That’s what Andreas Gruentzig, the father of coronary angioplasty, said to me back in 1985. He knew that looking at the angiogram alone was not sufficient for judging the blockage in an artery. Integral to the design of his technological breakthrough, the double-lumen angioplasty balloon, was a feature which allowed him to measure the blood pressure at either end of the arterial blockage. At the start of the procedure, he could quantify how significant the blockage was; when he was done inflating the balloon, he could see the benefit of the dilatation. The post-angiogram might look good, but the pressures sometimes signaled that blood flow through the area was not. So, inflate again. And maybe again. OK, pressure now looks good, we’re done! Pretty simple. Not brain surgery. Continue reading
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