Category Archives: Stent

From Bench to Bedside to Bench Revisited: Supreme Court Justice Ginsburg Back in Action

  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

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Filed under Celebrity Patients, History, Media Coverage, Stent

Plavix and Aspirin After Stent: 8 Years Later – Is Longer Better?

plavix_and_stentNo one thought it would take quite so long to get this information, but in just a couple hours results from the Dual Antiplatelet Therapy (DAPT) Study will be presented at the American Heart Association Scientific Sessions 2014. The question to be answered: Is there a benefit to extending dual antiplatelet therapy (aspirin plus a thienopyridine, such as clopidogrel/Plavix, prasugrel/Effient, etc.) beyond one year after stenting?

This is a question asked back in 2006, during a special two-day FDA hearing, convened to discuss all known issues with drug-eluting stents and prompted by the “ESC firestorm” over the problems of increased incidence of late stent thrombosis in drug-eluting stents. (See “Problems Resurface with Drug-Eluting Stents” – September 9, 2006.) Continue reading

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Filed under Antiplatelet Medications, Bare Metal Stents, Clinical Trials / Studies, Drug-Eluting Stents, Global Trends, Meetings & Conferences, Optimal Medical Therapy, Stent Thrombosis

Fractional Flow Reserve: Measuring Pressures in the Marketplace

Dr. Andreas Gruentzig

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

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Filed under Business & Industry, Cost Effectiveness, FAME I / FAME II, FFR, History, Stent

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

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

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

Frontiers in Interventional Cardiology Symposium

If you’re an interventional cardiologist, Fellow, or in the allied health fields, and you aren’t able to make it to Washington for the five-day-long TCT meeting, you can get a quick dose of the latest and greatest in a single day on Saturday, September 20, in Short Hills, New Jersey.

Titled “Frontiers in Interventional Cardiology,” this symposium is presented by the Morristown Medical Center, part of the Atlantic Health System, and features a stellar international faculty, including Maurice Buchbinder, George Dangas, Eberhard Grube, Raoul Bonan, and Stephen Ellis. A range of contemporary topics are on the agenda, including a transradial talk by pioneer Olivier Bertrand, discussions about catheter-based treatments for mitral and aortic valve disease, and even a brief talk about Google Glass in the cath lab by Morristown Medical Center’s Jordan Safirstein, who also runs the annual MARS radial course at Morristown Medical Center

Course co-directors are Drs. Maurice Buchbinder, Barry Cohen and Robert Kipperman.  Time is short so register soon. Admission fees range from free (for Fellows) to $125 for physicians, with several levels in-between. You can register for the course online, or call 1-800-247-9580.

Did I mention that Fellows are free? #TakeAdvantageOfFreeCoursesWhileYouCanFellows

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Filed under Meetings & Conferences, Stent, Transradial Approach

Angioplasty Arrives in the Outback: First Stent Placed in Northern Territory

Northern Territory - AustraliaIt’s been over 35 years since the first angioplasty was performed in Zurich by Dr. Andreas Gruentzig, but it was just yesterday that this minimally invasive procedure arrived in Australia’s Northern Territory.

As reported today by Sky News, Dr. Marcus Ilton, chief cardiologist at Royal Darwin Hospital, performed the first angioplasty and stent implantation ever done in the NT. Continue reading

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Filed under Global Trends, Media Coverage, Stent